Common causes of work-related illness

Last reviewed on 28/11/2012 15:49

In 2007/08 an estimated 2.1 million people in Great Britain were suffering from an illness they believe was caused or made worse by their current or past work (UK Labour Force Survey, 2008).

One way you can minimise the impact of work-related illnesses include carrying out a risk assessment for your work activities. View further details on these illnesses.

Back pain

Back pain is currently the largest reported reason for sickness absence in the UK. Back pain can be caused by many situations, however it is more common in some jobs e.g. roles that involve heavy manual labour, repetitive tasks, extensive driving, sitting at a workstation for a long time or manual handling. Back pain comes under the umbrella term of musculoskeletal disorders (MSDs).

Whilst not all back pain can be prevented, the employer has an important role in controlling workplace factors associated with these conditions, and encouraging employees to report back pain at an early stage and seek appropriate treatment.

There are various legal obligations that the employer must meet:


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Musculoskeletal disorders (MSDs)

Musculoskeletal disorders (MSDs) are amongst the most commonly reported work-related condition in Britain. These disorders affect muscles, joints, tendons and other supporting tissue and are associated with pain and reduction in the normal range of activity. Musculoskeletal disorders is an umbrella term which includes back pain and upper limb disorders.

What causes them?

MSDs are a problem in nearly every workplace and can be caused by a number of factors, including, but not limited to:

  • manual handling (e.g. lifting, lowering, pushing, pulling and carrying)
  • repetitive movements, uncomfortable working positions
  • working too long without breaks
  • psychosocial factors
  • display screen equipment (DSE).

The role of the employer

Whilst not all MSDs can be prevented, the employer has an important role in controlling the workplace factors associated with these conditions, and encouraging employees to report MSDs at an early stage and seek appropriate treatment.

Steps you can take to help prevent MSDs:

  • Identify high risk workplace activities, particularly those affecting most employees. HSE has developed two online tools, the Manual Handling Assessment Chart (MAC) HSE Manual Handling Assessment Chart Tool (external link) and the Assessment of Repetitive Tasks of the upper limbs (ART) HSE ART tool (external link) to assist you in this process.
  • Provide appropriate information and training on safe movement and handling activities, work with VDUs and activities involving use of force, frequent repetition, uncomfortable work positions, and high job demands.
  • Provide information on fitness and healthy lifestyles.
  • Involve employees and safety representatives at an early stage in developing risk reduction measures for those activities which cannot be avoided, and in planning new work activities.
  • Encourage early reporting of MSDs, and monitor trends in absence to identify which work groups are most at risk.
  • Establish early and regular contact with the employee, to ensure that they have access to appropriate advice and support from their GP and, where available, Occupational Health service and therapists such as physiotherapy.
  • The longer a worker is off work with back pain, the less likely it is that they will return. Try to facilitate an early return to work by making temporary adjustments to their work role or place of work.
  • Investigate work-related injuries and risk management strategies as appropriate. Ensure you are complying with relevant legislation.


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Upper limb disorders (ULDs)

Work-Related Upper Limb Disorders, or ULDs, is the name given to a group of clinical conditions affecting the upper limb such as Tenosynovitis, Carpal Tunnel Syndrome (CTS) and Tennis Elbow. At one time they were known as Repetitive Strain Injuries (RSI). Now they are called ULDs because it is recognised that repetition is only part of the problem; other factors are important as well. However, some doctors and others still use the term RSI, often for aches and pains that don't fit into the clinical categories. ULDs affect the shoulder and arm, including the forearm, elbow, wrist, hand and fingers.

ULDs can also include neck pain. There is a wide range of symptoms, such as tenderness, aches and pain, stiffness, weakness, tingling, numbness, cramp, or swelling.

What causes them?

Many jobs carry a slight risk of developing aches or pains in part of the arm or shoulder. If untreated, and continually aggravated, these aches can develop into a ULD. It is important to note that ULDs are not always caused by work. For example, CTS can be due to a hormone imbalance, particularly in women. However, many jobs can still aggravate pre-existing ULDs.

The exact cause of many ULDs is not clearly known. But it is known, in general, that there are three factors which can provoke or cause them:

  • Posture of the arm or the angle at which it is held. For example, the wrist works best with the hand and arm in a reasonably straight line. If it is twisted, rotated or bent this will increase the strain on the tendons and nerves that pass through the wrist to the hand.
  • Force or tension which is created in nerves and tendons. Directly applying a force, in activities such as folding boxes or twisting wires can cause this. Or alternatively, the force may be created using tools such as pliers, scissors or knives.
  • How long a force is applied or how often the action is carried out.

Additionally, the way in which work is organised and managed can also be a factor in causing ULDs or making them worse. These factors are interlinked: for example, the more awkward the posture is then the lower the level of force or tension which can be easily and safely withstood. The more strain that is generated by an action the less often it can be held or repeated without causing problems.

Steps you can take to help prevent ULDs:

  • Identify risks through risk assessments
  • Seek ergonomic advice on work and workplaces. In many cases, awkward postures, forces or repetitive movements are part of what people do as their job. Identifying these and helping to put them right is part of the science of ergonomics. Ergonomists help to study the work, point out where actions may create too much strain, and work with engineers and others responsible for designing work to try to remove or reduce the problems.
  • Provide suitable education and training. Training in good techniques, and education to explain the reasons for these techniques helps to ensure that all staff, at whatever level, recognise and appreciate the risks. This includes information on the correct way to carry out the job so that employees follow proper procedures, use tools or equipment correctly and avoid bad habits.
  • Ensure that organisational factors and production pressures (e.g. targets, bonuses, etc) do not encourage actions which may carry a risk. If the correct way of doing something is unavoidably slower, then this must be taken into account.
  • Encourage early reporting of symptoms by workers and make arrangements for the proper treatment and rehabilitation of ULD cases.


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Display Screen Equipment (DSE)

Display Screen Equipment (DSE) has become one of the most common kinds of equipment used at work. It refers to any work equipment having a screen that displays information. Typical examples are computer screens, often called monitors or VDUs. Problems with DSE are generally caused by the way the DSE and associated equipment is used, not by the actual DSE.

Computer workstations or equipment can be associated with neck, shoulder, back or arm aches and pains, fatigue and eye strain. These aches and pains are sometimes called upper limb disorders (ULDs) or repetitive strain injuries (RSI). See the corresponding information above for further information on ULDs.

The role of the employer

The employer has a duty to ensure they comply with the DSE requirements by assessing both the workstation and the working environment of employees who regularly use computer workstations and display screen equipment. The employer should ensure that workstation assessments are carried out by appropriately competent and trained assessors. Following any assessment, suitable adjustments should be made to the workstation as required for the user.

Steps to help prevent problems associated with DSE use

The DSE Regulations set out guidance on the minimum standards and requirements for working with Display Screen Equipment (computers) and highlight possible risks to health from using such equipment, such as upper limb disorders (ULDs). The employer has a duty to ensure that they comply with the Regulations by assessing both the workstation and the working environment of those employees who regularly use computer workstations and display screen equipment:

  • analyse workstations to assess risks and take actions to reduce those risks
  • ensure all workstations used meet the minimum requirements laid out in the DSE Regulations
  • plan work so that there are breaks or changes of activity. For most people, taking a break to do something else is sufficient. However, where an employee works exclusively at a computer, then provision should be made for rest breaks.
  • a DSE user can ask for an eye test and, when they do so, the employer has a duty to provide one. If the user requires a special set of glasses for use at the display screen and cannot use normal ones then the employer is required to provide them. Eyesight testing is not compulsory but is often a useful first step to take if staff complain of problems that might be linked to the use of display screen equipment (for example sore eyes and headaches).
  • provide appropriate training and information on DSE use.
  • Healthy Working Lives has produced a DSE workstation risk assessment form that can help you with this process. The form takes you through the assessment process as well as offering advice that could help you to remedy some of the problems you may have in the assessment.

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Occupational asthma

Asthma is characterised by inflammation in the airways which can lead to symptoms such as cough, wheeze, chest tightness and breathlessness. Work-related asthma is a broad term which includes those individuals with pre-existing asthma, whose asthma is made worse by substances in the workplace (work-aggravated asthma) and those individuals who, regardless of pre-existing asthma, have asthma caused by occupational exposure to an allergen or irritant.

This latter group, which has true ‘occupational asthma’ falls into two categories:

  • sensitiser-induced occupational asthma
  • irritant-induced occupational asthma.

Respiratory irritants are substances that may trigger attacks in both those with occupational asthma or pre-existing asthma e.g. chlorine or dust.

Substances which cause occupational asthma are known as respiratory sensitisers and can be manufactured chemicals or naturally occurring materials, such as hard wood dust. Once initiated the sensitisation process is irreversible. A substance is considered to cause occupational asthma if it is able to produce both the physiological changes associated with this hypersensitive state in the airways, and trigger subsequent attacks.

Symptoms can develop right after exposure to a substance, or they can appear several hours later, possibly at night. This can make it difficult to establish a link with workplace activities. The Health Risks at Work initiative has additional information on breathing risks and a risks to breathing video (external link) to aid understanding.

If an individual develops occupational asthma, exposure must be controlled to prevent triggering of further attacks. If notified of the case in writing by a doctor, the case needs to be reported to HSE as required by RIDDOR 1995.

The role of the employer

The employer has an important role to play in controlling workplace exposures, in providing appropriate health surveillance and encouraging employees to report symptoms at an early stage.

Steps to help prevent occupational asthma

  • go through your risk assessment and identify all known respiratory sensitisers and substances which are a potential cause of occupational asthma. Further information and guidance is available in the COSHH Regulations 2002, CHIP Regulations 2009 (risk phrases R42 and R43), CLP Regulations 1272/2008, and COSHH Essentials.
  • in discussion with employees and their representatives, implement effective control measures to reduce the risk of exposure. Consider substitution, segregation, bulk handling or wet processes, and effective extraction. Seek to limit peaks of exposure, and provide adequate hygiene facilities. Use RPE where adequate control cannot be achieved by other methods.
  • provide appropriate information and training on typical symptoms and pattern of occupational asthma, likely workplace causes, reporting procedures, correct use and maintenance of control measures, safe working practices, correct use of RPE where applicable and appropriate action in the event of emergency.
  • promote healthy lifestyles and encourage smoking cessation.
  • establish regular health surveillance for all employees exposed to or liable to be exposed to a substance which may cause occupational asthma. The extent and frequency of surveillance should be agreed in consultation with an occupational health professional.
  • maintain a health record for each individual, retained for 40 years.
  • encourage early reporting of asthma symptoms, and protect the person from further exposure while the cause of the symptoms is fully investigated. This should include a review of the risk assessment and risk management strategies.


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Occupational dermatitis

Dermatitis is characterised by redness, itching, scaling, rashes, hives or blistering of the skin. The two common forms of dermatitis usually seen in the workplace are allergic dermatitis and irritant contact dermatitis.

  • Allergic dermatitis is caused by an immune response following skin contact with an allergenic, or ‘sensitising’, substance. Skin reactions may not be caused on initial contact, but after repeated exposure, some people will have an allergic reaction. Once a person is ‘sensitised’ to a substance, it is likely to be permanent and contact with the substance, even in very small quantities, may result in a reaction.
  • Irritant contact dermatitis is the more common form of occupational dermatitis and occurs when something damages the surface of the skin faster than the skin is able to repair the damage. Irritants act directly on the skin through chemical reactions and can be chemical, biological, mechanical or physical.

In the workplace

When the skin comes into contact with hazardous substances at work, this can cause occupational dermatitis to occur. Substances which might cause occupational dermatitis include cleaning products, organic solvents, metalworking fluids, cement, adhesives, other chemicals, and even certain plants.

The employer has an important role in controlling workplace exposures to agents which cause occupational dermatitis and in providing appropriate health surveillance and encouraging employees to report symptoms at an early stage.

The Health Risks at Work initiative has additional information on risk to skin and a video to aid understanding of risks to your skin (external link).

Steps you can take to help prevent occupational dermatitis:

  • Go through your risk assessment and identify all known primary skin irritants and sensitisers which are used in your workplace. Risk assessment and risk management strategies should be reviewed regularly.
  • Implement effective control measures to reduce the risk of exposure. Consider substituting potential skin irritants/sensitisers with products that have a lower chance of causing a reaction. Provide adequate hygiene facilities, soaps and barrier creams, and appropriate PPE (e.g. gloves and coveralls).
  • Promote good personal hygiene and good housekeeping in the workplace. Encourage employees who are potentially at risk of occupational dermatitis to examine their skin regularly.
  • Educate your employees on the likely workplace causes of occupational dermatitis and how to recognise the symptoms. Information and training should be provided on skin hygiene and skin care at work, correct use and maintenance of PPE, and reporting procedures.
  • Encourage early reporting of symptoms (external link) and protect the worker from further exposure while the cause of the symptoms is fully investigated. Other individuals in the same work group may have similar skin problems; make sure to check them out too. Always investigate employees’ concerns and be sure to consult with your employees and safety representatives.
  • Establish contact with the employee at an early stage to ensure that they have access to the appropriate advice and support from their GP, and where available Occupational Health service. Referral to a dermatologist may be appropriate.

Work-related noise and hearing loss

When individuals are exposed to high levels of noise in the workplace, it can lead to permanent hearing damage. This damage can cause poorer hearing ability (general hearing loss), as well as a condition known as tinnitus, which manifests itself as a constant ringing in the ears. Loss of hearing can have a huge impact on a person’s life e.g. conversations can become difficult to follow, and they have trouble using the telephone. Tinnitus can be a very distressing condition and can lead to disturbed sleep. There is no treatment available to cure either condition.

Noise is measured in decibels (dB). An ‘A-weighting’ sometimes written as ‘dB(A)’, is used to measure average noise levels, and a ‘C-weighting’ or ‘dB(C)’, to measure peak, impact or explosive noises. Decibels are a logarithmic unit. A reduction in noise of 3 dB is the equivalent of halving the intensity of the noise. A person could work for twice as long at the reduced level and have the same daily personal noise exposure as before. Therefore a reduction in noise exposure of just a few decibels can make a big difference.

The role of the employer

The Control of Noise at Work Regulations 2005 places a general duty on employers to reduce the risk of hearing damage to the lowest level reasonably practicable. The Noise Regulations require employers to take specific actions at certain action values. The action values relate to:

  • the levels of exposure to noise of your employees averaged over a working day or week and
  • the maximum noise (peak sound pressure) to which employees are exposed in a working day.

At the lower exposure action values of a daily or weekly exposure of 80 dB(A) and a peak sound pressure of 135 dB(C), you are required to take certain actions, such as the provision of hearing protection, information, instruction and training etc.

At the upper exposure action values of a daily or weekly exposure of 85 dB(A) and a peak sound pressure of 137dB(C), further management action is required, including controlling the noise at source and designating hearing protection zones where the use of ear protection is mandatory.

There are also levels of noise exposure which must not be exceeded at any time, called exposure limit values. These values do take into account the effects of wearing hearing protection i.e. the dB experienced by a person wearing hearing protection will be lower than the dB produced by the source of the noise. These values are a daily or weekly exposure of 87 dB(A) and a peak sound pressure of 140dB(C). More details of noise risk and preventative measures.

Steps to help prevent work-related noise and hearing loss

The Control of Noise at Work Regulations 2005 require employers to prevent or reduce risks to health and safety from exposure to noise at work, employees have duties under the Regulations too. The Regulations require you as an employer to:

  • assess the risks to your employees from noise at work
  • take action to reduce the noise exposure that produces those risks. Typical solutions may include improved maintenance of equipment, installation of acoustic screens or enclosures, or relocation of noisy equipment to remote locations
  • provide your employees with hearing protection if you cannot reduce the noise exposure enough by using other methods
  • provide your employees with information, instruction and training, including where to obtain the ear protection, how to fit it and when and where it should be worn
  • make sure the legal limits on noise exposure are not exceeded
  • carry out health surveillance where there is a risk to health.


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Stress can be defined as the adverse reaction people have to excessive pressure or other types of demand placed upon them. Work-related stress arises where work demands exceed the person’s capacity and capability to cope.

Work-related stress is a significant cause of illness and is linked with high levels of sickness absence, staff turnover and work errors.

There are strong links between stress and physical effects such as heart disease, back pain, headaches, gastrointestinal disturbances or various minor illnesses. There are also strong links with psychological effects such as anxiety and depression, loss of concentration and poor decision making.

The role of the employer

The employer has an important role in controlling workplace factors which have been shown to be associated with work-related stress, and encouraging employees to report concerns at an early stage and identify appropriate support. Additionally, while the employer is not under a legal duty to prevent non-work factors, a supportive environment will help employees to seek help for other issues and minimise their impact at work.

The HSE has developed Management Standards as a key approach for dealing with work related stress. The HSE Management Standards (external link) represent a set of conditions that, if present, reflect a high level of health, wellbeing and organisational performance.

Steps you can take to help prevent work-related stress:

  • Identify risk factors within the workplace, particularly those involving most employees. Seek feedback from employees and their representatives. The HSE Management Standards can assist you in this process.
  • Involve employees and their representatives at an early stage in developing risk reduction measures, and planning workplace change. Aim for flexibility. Consider aspects of job demands, work role and relationships, and the level of control employees have in their role and the support they receive.
  • Encourage early reporting of stress by encouraging managers to have an open and understanding attitude, to be aware of signs of stress and groups at risk.
  • Establish contact with the employee at an early stage, to ensure that they have access to appropriate advice and support from their GP and, where available, Occupational Health service and other specialists or counsellors.
  • Investigate all reports of work-related stress and try to identify the source(s), and review risk assessment and risk management strategies as appropriate.
  • Work with the employee to reduce the risk by making adjustments to the work role or place of work, or providing additional training or resources. Healthy Working Lives provides free one day and online courses to support implementation of the Work Positive process. Places are on a first-come first-served basis. Find your nearest Managing Stress in the Workplace course.
  • Provide information on healthy lifestyles, and encourage employees to have a healthy work-life balance.


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