Analysis: Back pain shown to afflict majority of practitioners

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Not only are early years workers suffering physical damage on the job, but many assume that it just goes with the territory and neither complain nor seek help. Caroline Roberts reports.


Back pain has long been considered an occupational hazard for the early years workforce, but the evidence has been largely anecdotal. Now, new research shows how widespread the problem is. The survey of early years and primary education professionals found that 88 per cent of respondents suffered back pain, with 82 per cent experiencing pain from a variety of musculoskeletal disorders at least once a week. However, it appears that the majority are suffering in silence, as only 8 per cent had officially reported their problems to their employer.

Of particular concern was the finding that more than a third kept quiet about it because they feared it would jeopardise their career. 'Management see it as part of the job, so no action is taken,' said one respondent. Another reported being told by her manager to take more painkillers and if she still had a problem then it would be possible to find someone else to do the job.

Lorna Taylor, the chartered physiotherapist who designed and carried out the survey, says, 'Given the amount of legislation in place to ensure the health and safety of employees in other sectors, I find it surprising that there is so little attention being paid to keeping the enormous number of employees in the education and care sectors safe and injury-free.'

The survey, carried out in autumn 2010, consisted of postal questionnaire responses from randomly selected members of Voice, the union for education professionals. Members of the union, and those of the National Union of Teachers, were also invited to participate online.

Of the 705 responses received, 215 were from staff working in pre-school settings. The incidence of back pain, joint pain and repetitive strain injuries was similar in staff working across all age ranges from nursery to primary. Of the pre-school staff responding, 86 per cent said they experienced back pain on a regular basis, 69 per cent suffered neck pain, and 57 per cent had discomfort in their knees (see box).

Early years practitioners are vulnerable to both back and neck pain because the job involves working at low levels, such as sitting at child-sized tables or on the floor.

Ms Taylor explains, 'Sitting with knees higher than hips rotates the pelvis backwards and pushes the spine into a C-shaped curve, whereas it should be in a slight S-shape with lower spine in. If you're in a C shape with shoulders slumped, keeping your head in an upright position causes compression in the vertebrae in the neck.'


Many of the problems reported by employees in early years settings were also caused by lifting children, constantly picking things up from the floor, and moving furniture and equipment - a particular problem for pre-school staff in shared premises.

One respondent mentioned the ergonomic problems caused by simultaneously feeding one child in a high chair, one at a table and another in a baby bouncer, which required her to twist from one to another while seated on a static chair. Others spoke of discomfort caused by activities such as moving scooters in and out of storage sheds, often without the use of a ramp, transporting tables and other equipment outside, and moving heavy sand and water trays.

There is evidence of a longstanding belief among the early years workforce that pain is an unavoidable part of the job. Georgina Smith worked for 21 years in a nursery unit and hoped to continue until the age of 60. However, she was recently forced to retire at 57 after years of neck pain, which doctors said was caused by her posture at work.

'When I started (working in nursery), all the staff of the older generation told me that one of the outcomes of being a nursery nurse is that you would end up with a bad back or possibly arthritis,' she says. 'I never went to my employer and said I was off because of the working conditions - I didn't know what they could do.'

The survey suggests that problems are by no means confined to longer-serving members of the workforce. Staff who had worked with young children for fewer than five years had similar levels of pain to those who had worked for more than 20 years. Two respondents in their thirties had already undergone back surgery. Another who had only been working in a nursery for two years said, 'I don't want to appear as if I'm not coping, or let the team down, so I just carry on through the pain.'


Vicki Moult, 35, has worked in early years settings for the past 12 years. She recently underwent surgery to realign the bones in her lower back. Although she believes that the problem was originally caused by childbirth, it was exacerbated by her working conditions.

'I also suffered with the day-to-day problems that all staff seem to have, such as pain in the shoulders,' she says. However, the situation has improved substantially since her school, Larklands Infant and Nursery in Ilkeston, Derbyshire, has invested in ergonomically designed chairs for all staff. 'It's 100 per cent better since we've had the chairs,' says Ms Moult.

The school introduced the chairs, which come in varying sizes to allow staff to work at the correct height, as part of a healthy back policy. 'They cost in the region of £150 each, so they're not cheap - but people are a lot more expensive to replace than chairs,' says head teacher Helen Smith. 'It's important to create a culture where members of staff feel able to say that they have an injury and need something to help and support them in their work. It's not that they can't do the job, it's about having the tools there to be able to support them in doing the job.'

The school has adapted layout and storage so equipment is at child height and can be self-accessed, thus reducing the amount of lifting and moving of boxes by staff. It has also introduced an exercise group after school on Fridays in which staff use DVDs to try out different forms of exercise, such as yoga and the aerobic exercise tae bo.

Lorna Taylor says, 'There is good evidence that prevention-focused strategies, including information, training and appropriate equipment, can result in savings for an organisation in terms of increased staff efficiency and reductions in absence. I hope that this study prompts research on a national scale which will lead to significant changes in practice.'



Of the 215 early years staff taking part in the survey:

Nature of pain
86% of respondents reported back pain
69% neck pain
57% knee pain
35% hip pain

86% experience pain at least once a week
37% experience pain daily

Attitudes and reporting
38% had been absent from work due to pain
66% had received either NHS or private treatment
9% reported and officially recorded problems
84% accepted pain as part of the job
40% did not report pain as they feared it would jeopardise their job



Employer measures:

  • - Store heavy items at around waist height
  • - Consider ergonomically designed furniture for staff
  • - Ensure that staff take regular breaks and that repetitive tasks are rotated
  • - Encourage staff to report and seek help for problems
  • - Arrange training annually in moving and handling and workplace ergonomics

Employee measures:

  • - Maintain general fitness - exercise such as yoga and Pilates are particularly good for developing flexibility and strong core muscles which protect the spine
  • - Eat healthily and avoid excessive weight gain
  • - Develop an awareness of correct posture
  • - Note any aches and take action by adjusting position or seeking advice
  • - Work at adult height whenever possible



  • - The charity BackCare has recently launched an application, Back Care - for Back Pain and Bad Backs, for use on iPhone, iPad, and iPod Touch. The application has a range of information and video exercises and is available free from or from iTunes
  • - Manual Handling for Childcare Professionals is an e-learning course provided by Learn HQ,
  • - Acorn Childcare Training provides courses on Manual Handling in Childcare Settings. Visit
  • - Lorna Taylor's website includes resources such as relevant HSE information and self-assessment staff questionnaires
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