Millions of UK workers spend most of the working day on their feet… with significant health and safety implications.

SUMMARY

Stand and Deliver

At the height of the Victorian era, doctors in Paris, London and New York began to report large numbers of “shop girls” suffering foot ailments caused by prolonged standing.

Concern was so great the physicians were moved to “launch campaigns to reform women’s dress and to enact statutes requiring employers to provide seats for their female employees so they would not be compelled to stand” all day.

Dr Arthur Edis, in a letter to the Times on 7 November 1878, called for an end to “slavery in the West End”, warning of the dire health consequences for London’s shop assistants of constant standing. Two years later, the Lancet launched an editorial campaign against “this cruelty to women”. Even then it wasn’t news. Bernardino Ramazzini, the “father of occupational medicine,” called in 1700 for a reduction in the amount of work requiring constant standing.

The problems have not gone away. Today in Britain’s meet-and-greet, have-a-nice-day service sector, major UK retailers still insist staff stand and deliver. And workers from machine operators to casino dealers, postal sorters to laundry workers can spend almost all their working day on their feet.

And it is not just their feet that suffer. Prolonged standing at work has been linked to health problems including foot, leg and back pain, varicose veins, and circulatory problems.

In 2005, millions of UK workers, including substantial numbers in the retail and manufacturing sectors and employed by major UK companies, spend most or all of their working day on their feet.

At risk jobs include:

European studies suggest between one-third and half of all workers spend more than 4 hours a day on their feet, either standing or walking. This means more than seven million and possibly as many as 11 million UK workers could spend at least half their working day on their feet. Some, like machine minders or retail workers hemmed in behind checkouts, sometimes have scarcely the room or opportunity to move their feet at all.

Professor Karen Messing of the University of Quebec in Montreal (UQAM), the author of several papers on the risks of prolonged standing at work and who has worked in Europe and North America:  “A really common reason for workers to stand is ‘image’. In the West… standing is thought to convey availability and courtesy; sitting in the presence of customers may be thought rude.

Health Effects

Standing most of the working day every day is not good news for the lower limbs  -  it can damage joints, make muscles ache and cause problems with the feet ranging from bunions and corns, to heel spurs and flat feet.

The most commonly reported symptoms appear to be discomfort, fatigue and swelling in the legs. Workers required to spend too much time on their feet are at greatly increased risk of pain and discomfort affecting feet, shins and calves, knees, thighs, hips and lower back.

The Health and Safety Executive’s latest estimates of the extent of occupational ill-health in the UK, show musculoskeletal disorders are the most common causes of work-related ill-health, and that 17 per cent of these disorders affected the lower limbs. The HSE figures suggest 192,000 people in the UK are suffering occupational lower limb disorders caused or made worse by their work. Lower limit disorders led to 2.2 million lost working days in 2003/04, according to HSE’s estimates.

There are many other debilitating and potentially very serious health concerns. “Worsening of existing coronary heart disease as well as varicose veins and chronic venous insufficiency have been associated with prolonged standing. Pain in the lower limbs and feet are also associated” according to UQAM’s Professor Messing.

A 2002 review of 17 studies of the health risks associated with prolonged standing concluded these included chronic venous insufficiency and musculoskeletal pain of the lower back and feet.

Older workers and those employed in heavy manual jobs frequently develop knee and joint pain as they get older, and may become progressively less able to cope with constant standing on hard floors. Other workers  -  for example, those with varicose veins, arthritis or who have suffered a back or lower limb injury  -  may also find themselves in difficulties.

Standing Symptoms

•  Painful feet and legs
•  Swelling in feet and legs
•  Bunions/corns
•  Heel problems, including plantar fasciitis/heel spurs
•  Achilles tendonitis
•  Varicose veins
•  Orthopaedic changes to the feet, including flat feet
•  Low back pain
•  Restricted blood flow
•  Immobilisation/locking of joints
•  Arthritis in knees and hips
•  Stiffness in neck and shoulders
•  High blood pressure
•  Heart and circulatory problems

Affects of the Job

The health effects associated with prolonged standing will vary with the job  -  whether for example, you are standing still, required to lift materials or operate machinery, or whether you are required to walk some or all the time.

Several job specific factors can lead to problems. Joint compression, caused by joints bearing the whole weight of the body and any load while standing, can lead to wear and tear and arthritis. Muscle fatigue can occur, as both standing and walking require constant muscle work. Prolonged standing can also reduce circulation of blood (venous insufficiency) and other body fluids, causing them to pool in the lower legs, leading to swelling and possibly varicose veins.

ILO’s Encyclopaedia of Occupational Safety and Health says varicose veins “are usually associated with long periods of standing in one position without movement, during which the static pressure within the veins is increased”

Constant walking, particularly on hard surfaces, can cause progressive damage to bones in the foot, including the heel. With each step, the heel lands of the floor with a force of 1.5 to 2 times a person’s body weight.

Some job designs are so lacking they can greatly exacerbate strain on joints and muscles. Badly designed checkouts can require retail workers to stand with their feet fixed while twisting their upper bodies and moving goods. Shopworkers’ union Usdaw estimates that a checkout worker lifts up to two tonnes of goods in an average 4 hour shift.

Other jobs even require workers to stand in the “flamingo position”, with one leg bearing the body’s weight while the other operates a machine pedal. This is not uncommon in textiles and manufacturing jobs.

In July 2005, retail union Usdaw launched a national campaign to reduce chronic back pain in checkout staff. The union says thousands of shopworkers suffer from chronic back pain as they twist and turn lifting up to two tonnes of goods in an average four hour shift at checkout stations that are frequently badly designed.

“There’s not many industries where workers are expected to handle two tonnes of products every four hours,” said a Usdaw spokesman “so it’s vital that checkouts are well designed to reduce back problems which currently cost British industry 4.9 million working days every year”

Making a Stand

Constant sitting is not the safe alternative to constant standing, in fact prolonged sitting is pretty bad for you too. The option to sit, stand, move around and vary the nature of work tasks is the preferred, healthy option.

There are two essential principles of good workplace design: No working posture is so good that it can be maintained for any length of time without variation; and no two individuals are alike, so the workstation has to be adapted to the individuals using it.

For workers who are used to doing a job in a particular way at a particular workstation, standing may seem like an uncomfortable but inevitable part of the job. If part or all of your job requires standing and everything has been done to reduce the amount of time spent on your feet, it is possible to minimise the risks through improved workstation design, job design and Anti-Fatigue matting. 

Factors to consider include the physical layout of the workstation. The tools and position of keys, controls and displays, for example, determine the body positions a worker has to adopt.

Possible workstation adaptations can include:

•  Adjustable height work surface. If the work surface is not adjustable, install a platform to raise a shorter worker and a pedestal to raise the work piece for a taller worker
•  Room for workers to change body positions
•  A foot-rail or footrest enabling workers to shift weight from one leg to the other
•  Elbow supports for precision work
•  Padded kneeler in front of workers allowing them to kneel slightly forward while performing tasks in front of them
• A seat for resting if standing is unavoidable

The Floor We Stand On

Standing fatigue starts at floor level and works its way upwards.  Hard, concrete floors are about the worst possible surface to work on.  Materials that provide flexibility such as rubber, plastic, wood, cork or carpet are gentler on workers’ feet.

Better still is Anti-Fatigue matting, properly designed to stand up to the required level of wear and to resistant oils, coolants and other fluids where necessary.  Concrete or metal floors should be covered with Anti-Fatigue matting with ramped safety edges to avoid any trip hazard. Machines should be mounted to reduce vibration through the floor.

Anti-Fatigue matting can be used wherever workers have to stand for long periods. Thicker and softer matting is not necessarily the best.  Better qualities will retain their fatigue-reducing benefits for many years when properly matched to the level of usage and other environmental conditions. 

The acid test of any measures is user opinion.  Wherever possible, users should be enabled to evaluate proposed workplace improvements for themselves.

The Law at Work

Employers have a general duty under section 2 of the Health and Safety at Work etc Act 1974 to do all that is reasonably practicable to protect their workers’ health and safety.

The Management of Health and Safety at Work Regulations 1999 says employers are required to carry out a suitable assessment of the risk to employees and others from work, eliminate risks where possible, or provide suitable control measures where it is not possible (regulation 3).
 

Safety Representative’s Checklist

•  Don’t accept standing on hard surfaces is inevitable  -  make sure management investigates workplace improvements

•  Ensure all jobs have been subject to risk assessments  -  walking and standing are work activities that should be considered

•  Where standing is required, ensure workstations have been adapted and work methods reviewed to reduce the risks, and take measures to reduce the hardness of the floor

•  Investigate whether job rotation or job enlargement could make jobs better and healthier

•  Look at all aspects of the job  -  lifting, twisting and reaching, for example, could exacerbate problems caused by prolonged standing

•  Anti-Fatigue matting can be introduced to make standing work more comfortable, but should be done in consultation with the users themselves… they know what works.

•  Employers must take measures to accommodate workers with disabilities that may be aggravated by prolonged standing on hard floors