- Majority of early years staff are suffering from ‘chronic’ muscle and bone pain due to working at low heights and floor level, lifting and stooping, finds research.
- Despite this pain, many continue to suffer in silence and if they have reported it to their employer, little to no action has been taken.
- Chronic pain has led to some early years staff considering leaving their job, amid a continued recruitment and retention crisis for the sector.
Early years staff are dealing with ‘chronic’ back, neck and shoulder pain, caused by work-related physical strain, with many accepting it is ‘part of the job’ and managing the pain themselves.
New research by the University of Derby detailing the musculoskeletal pain (MSP) of 196 people working in the early years sector in England and Wales reveals 99 per cent have experienced some form of musculoskeletal pain, with lower back pain being the most common.
Despite the pain being caused by carrying out ‘high risk’ musculoskeletal actions, such as lifting, stooping, and working at low heights and floor level within the workplace, many said they hadn’t reported it to their employer, believing it is part and parcel of the job; they admitted they have continued to work, in some cases taking daily painkillers rather than go on sick leave.
The findings come nearly a decade after Nursery World ran its own survey on the impact of nursery work on physical health, which found staff were experiencing an ‘epidemic’ of back, neck and knee pain, with many choosing to suffer in silence, suggesting little has changed.
Areas of pain and severity
Almost all participants (99 per cent) that took part in the University of Derby research reported pain in at least one part of the body, with 72 per cent experiencing pain in at least four locations.
A breakdown of the figures shows that 27 per cent experience pain in one to three areas, 47 per cent in four to six areas, 20 per cent in seven to nine areas, and 5 per cent in ten or 11 areas. A total of 89 per cent reported experiencing lower back pain, 64 per cent neck pain, 63 per cent knee pain, 59 per cent shoulder pain, and 49 per cent hip pain.
Pain in hands, feet, upper back and wrists was also reported, but by fewer respondents.
According to the findings, pain in the lower back was more likely to be the most severe; however, upper back pain was most frequently occurring, and pain in the feet and ankles was most likely to last longer.
The majority of early years staff that took part in the research said they had reported their pain to a health professional; however, this had only resulted in a formal diagnosis for around half of cases. The researchers say this ‘demonstrates the significant burden of pain that people live with that may be overlooked by official figures and measures’. This is supported by the low rate of recorded absence due to MSP, with just a quarter saying they had taken time off due to pain.
Key findings
- Lower back pain is most commonly experienced by early years staff.
- Those with pain were most likely to describe it as ‘mild to moderate’, occurring weekly and lasting between one and two weeks, having first occurred over 12 months ago.
- Leaders/managers were more likely to experience elbow pain and less likely to experience ankle pain than practitioners.
- The longer someone had worked in the sector, the more locations they reported experiencing pain, regardless of how old they were.
- The only thing that age affected was how long people’s pain lasted, with older people appearing to recover more slowly.
Personal experiences
Comments from individual respondents, due to be published within a separate research paper by the university at a later date, include:
‘When the pain is unbearable in bed I have often thought maybe I need another job.’
‘I’m only 26, what is my body going to be like in the next ten years?’
‘My back pain was severe at the time and I didn’t think I could go back to work.’
They also highlight that despite experiencing pain, many practitioners have not informed their employer.
When asked why they hadn’t reported their pain, one said, ‘It feels like it’s more or less an expected part of the job judging by the way other staff members describe their pain. Use of painkillers is a daily practice.’
This separate research also reveals that a number of respondents, mainly those who are self-employed or in leadership roles, felt they had no-one to report their pain to.
Many of those who had reported their pain felt they hadn’t received enough support, however. When asked what happened when they did report their pain to their employer, some respondents suggested little to no action was taken, saying, it was ‘just noted’, that there was ‘no significant follow-up or change’, and a ‘general health discussion’ took place.
Other responses included:
‘Measured for a chair that never materialised.’
‘Given a seat to use rather than kneeling on the floor.’
‘Gained access to a Jolly Back chair though still faced issues with table height.’
‘Supportive chair only after initiating a request.’
Action needed
Physiotherapist and founder of Jolly Back, Lorna Taylor, who contributed to the research, said the findings highlight the need to address the ‘endemic of chronic musculoskeletal pain among early years professionals though improved training, workplace design, ergonomic equipment and investment in occupational health.’
Lead report author Alistair Turvill (pictured) told Nursery World, ‘There is clearly a need to address this issue.
‘Better training and education (for practitioners, managers, and public) is needed, along with much better surveillance and proactive consideration of employees’ physical health (as a norm, and ongoing), carrying out full risk assessment, especially for overlooked areas such as working at floor level.
‘Adaption of environments (suitable furniture for adults, as well as children, considering the ergonomic strain involved in roles) is required, as is more rest time to recover after doing physical work.’
He added that wider factors affecting people’s pain – social and psychological factors such as lack of social support, economic hardship, inequality and poor living conditions – also need to be considered.
Sector comments
Comments responding to a post about musculoskeletal pain on Nursery World’s Facebook page further highlight the scale of the issue.
One respondent said, ‘Didn’t actually know this was a general issue with early years practitioners. I have issues with my wrist and elbows that only started happening after working in early years for years.’
A former childminder said, ‘One of the reasons I left early years – the abuse on my body, lifting children in and out of car seats, nappy changing, pushing triple buggy and also diagnosed with fibromyalgia. I recall a trainer on a manual handling course saying childcare practitioners had some of the worst MSK health – only construction workers, drivers and healthcare professionals had worse.’
Another commented, ‘I retired last year after working in the early years for 47 years. I was due an operation on my back because of severe low back pain and two slipped discs, but since retiring my back ache has improved greatly to the extent that I now don’t need the operation.’
What the law says
The Health andSafety at Work Act states that employers must protect the health and safety of their workers and other people who might be affected by what they do.
On top of this, the Management of Health and Safety at Work Regulations require employers to assess the risks to the health and safety of their workers, while the Manual Handling Operations Regulations require employers to carry out a risk assessment for all manual handling tasks that pose an injury risk.
Tips to take care of your back when working in early years settings
By Franck Pertois, back care advisor
‘Remember the key principles for lifting, carrying and lowering: adopt a stable base, keep your spine in line, keep the load close to you.
‘Wherever possible, avoid the manual handling situation, i.e. lifting, lowering, carrying, pushing and pulling. For example, encourage the child to do as much as possible, use equipment, work in pairs.
‘If avoidance is not possible, risk-assess: think about the task, your individual capacity, the load and the environment. Review your risk assessment regularly.
‘To pick up a baby or a small child from the floor, many people find it easier to half kneel. Drawing the child towards you and holding them close, you could pass the child to a colleague, or place them in a seat or buggy.
‘If you have to work at floor level, try to change your position as often as possible. Using a meditation-type stool can reduce the stress on your knees. Alternatively, a pad under the kneesand a cushion between the thighs and calves may relieve some discomfort.
‘If you have to assist a young child to walk, use a height-adjustable, wheeled stool for a stable and mobile base. Avoid stretching out to hold the child, keep them close.
‘Arrange activities to avoid or limit awkward posture.
‘Use equipment and ergonomic solutions, e.g. a wheeled trolley, a removable ramp.
‘Store items that you use and move regularly at waist level, for example, nappies and wipes.
‘Use an adult-height desk and chair for administration and regular computer/laptop use. A standing workstation can also be a positive solution.
‘Report back problems as soon as possible. Don’t ignore them.
‘If you have managerial responsibilities, remember you have a legal duty to make reasonable adjustments for your staff.
‘Attend training regularly and focus on prevention.’
- Franck Pertois is a trainer in early years, schools and social care settings. https://franckpertois.com
Case study: Zoe Wells
Zoe Wells has worked in the early years sector in various roles, including as a nanny and working in a nursery, for 40 years. Now a SEND manager at a children’s charity in London, she has suffered from back pain for years, resulting in a spinal fusion a decade ago. At just 57, she is planning to semi-retire at the end of the year.
She told Nursery World, ‘After a few years of pain and various interventions, I had to have surgery on my spine. I was told the cause was most likely from years working in an early years environment. Settings I worked in in the past were not very supportive, so I ended up taking a big pay cut and moving to the job where I am now.
‘I am no longer an on-the-floor practitioner, but do delivery sessions for parents of disabled children. My current employer has been very supportive and provided adjustments to help me manage desk-based work. This employer has been the best of my career; I started the job in lockdown. They are very understanding of my physical limits.
‘My pain has returned this year, however. My physiotherapist said it is most likely age-related. I am planning to semi-retire towards the end of the year.’
Case study: Victoria
Victoria, who is in her 20s, has suffered from a back injury, nerve damage and a fractured wrist as a result of caring for children with special educational needs and disabilities.
She told Nursery World, ‘I was 23 when I first experienced an injury while working in a nursery with pre-school-age children. I had to move a child with SEND who was throwing chairs, screaming, hitting staff, kicking and biting. The child jolted while hitting me. I ended up with a severe slipped disc injury and sciatic nerve damage.’
She said she struggled to straighten her back and walk to the bathroom from her bed. When the pain was at its worst, she was taking 32 tablets a day, alongside receiving intensive physiotherapy.
The nursery worker couldn’t take any more than seven days’ leave as her employer did not provide sick pay and she couldn’t afford to live on statutory sick pay. She reported the injury to her manager, but says she had to fight to be put on ‘lighter duties’.
Recovery took four months, but she continues to suffer complications from the injury.
The nursery worker suffered another injury this year to her wrist. Again, she was put on ‘lighter duties’; however, she says that other staff resented her because of it.
‘My injuries have made me more cautious when working with children with challenging behaviour. They also impacted my mental health as I felt immobilised and wasn’t able to carry out my normal duties.
‘I did consider leaving the sector because no job is worth sacrificing your physical or mental health for,’ she added.
General tips to take care of your back
- Wear comfortable clothes and flat footwear (avoid high heels and open shoes).
- Keep your weight under control. Regularly exercise. Stop smoking.
- Be mobile and change your position regularly, rest.
- Sleep well. Check the quality of your mattress.
- Pay attention to your posture. Avoid bending, twisting, stooping, over reaching.
- If carrying a bag, use a rucksack worn on both shoulders. If using a single strap bag, wear it across your body and swap sides regularly. Two bags of similar weight carried in each hand can also be an alternative.
Franck Pertois
FURTHER INFORMATION
- The research is published online in the journalScience Direct: https://www.sciencedirect.com/science/article/pii/S0925753524001826
- Legislation: https://www.hse.gov.uk/msd/legislation.htm
