What is a Lower Limb Disorder?
A lower limb disorder (LLD) is the term used for a range of conditions affecting the hip, thigh, legs, knees, ankles and feet. It covers those conditions with specific medical diagnosis (e.g., osteoarthritis of the knee and hip, or knee bursitis). Workers may also report lower limb pain, aching and numbness without a specific disease being identified.
LLDs at work may gradually develop over time or due to an acute injury, however they usually happen because of joint and/or muscle overuse.
The most common risk factors at work associated with LLDs are:
- repetitive kneeling and/or squatting
- fixed postures, e.g. prolonged standing
- climbing ladders or stairs
- heavy manual handling
LLDs are a major cause of sickness absence. Management of the risks can reduce the number of people experiencing sickness absence as well as reducing the period of each absence.
Whilst not all LLDs are work-related, experience has shown that they can be caused or made worse by work.
Ensure workers know how to report any injuries or symptoms.
Symptoms of LLDs
Symptoms may include aches, cramp, numbness, pain, stiffness, swelling, tenderness, weakness, and reduced mobility in the affected area, i.e., hip, legs, knees, ankles and/or feet.
These symptoms may suggest overuse, damage to the limb or some underlying condition.
If you are concerned, please speak to your Doctor/GP.
Work-related diseases of the lower limb
Scientific evidence suggests that there are several recognised diseases of the lower limb which can be work-related. These include:
- hip and knee osteoarthritis
- knee bursitis
- meniscal lesions/tears
- stress fracture/reaction injury
- varicose veins of the lower legs
Osteoarthritis (OA)
Osteoarthritis (OA) is a degenerative condition that affects the joints of the body (for example knees, hips and spine), and happens when the cartilage coating at these joints becomes damaged or worn away. Hip OA is more common among male than female workers and farmers have a significantly higher risk of suffering from it. There is a significantly increased risk of knee OA among miners, floor layers and cleaners.
Knee bursitis
Knee bursitis - also called coal miner's, carpet layer's or housemaid's knee - is caused by repetitive kneeling or knee-straining activities. Workers who develop bursitis generally report tenderness and swelling, and a reduction in knee movement due to pain and tightening of the skin over the kneecap.
It should be noted that bursitis or subcutaneous cellulitis, due to severe or prolonged external friction or pressure at or about the knee (beat knee) is a reportable occupational disease as required under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (NI) 1997 (RIDDOR) (as amended by Reporting of Injuries, Diseases and Dangerous Occurrences (Amendment) Regulations (NI) 2004).
Meniscal lesions/tear damage
If the knee is bent or twisted while bearing a load, the force may cause meniscal lesions or damage to occur. Overuse trauma, for example repetitive squatting or kneeling, can cause meniscal injury or damage. Such damage leans toward the injured knee being inclined to degenerative changes typical of OA.
Stress fracture/stress reaction injuries
Stress fracture and reaction injuries are the result of repeated micro-injuries to bone, typically found in those who regularly undertake marching or stamping of the feet. They are more common in people undergoing military training and in athletes, particularly long-distance runners.
Varicose veins
Varicose veins are any dilated subcutaneous veins of the leg. Workers may experience symptoms/feelings of heaviness, pain and swelling in the legs or restless legs or night-time calf cramping. These complaints can increase during the day, especially after heavy lifting or prolonged standing.
Preventing work-related LLDs
Whilst it may not be possible to prevent all cases of LLDs, you can do things in the workplace to help prevent LLD symptoms or stop them getting worse, whether they are caused or made worse by work activities.
Identification and risk assessment of the tasks associated with LLDs in the workplace are key steps to effectively prevent and manage work-related LLDs.
Implement suitable controls to protect workers from the causes of LLDs in the workplace.
An effective way to reduce the risk of LLDs is to design the work to avoid overuse of the lower limb joints and muscles. For example:
- adapt work methods
- provide mechanical aids
- use staff rotation to lessen the time spent carrying out 'risky' tasks
- facilitate regular breaks
- provide seating, where possible
- provide workers with appropriate instruction, information and training regarding the risks
Personal protective equipment in the form of knee pads provide useful protection while kneeling on hard floor surfaces, but they do not mitigate the risks of extreme flexion of the knee. Their benefit is largely in respect of preventing lacerations and penetrating injuries and improving comfort. It is not known whether they reduce the risk of osteoarthritis (OA).
There is some evidence that anti-fatigue matting may be effective in reducing the risks from prolonged standing. However, the use of mats in the workplace requires careful consideration because of the increased risk from slips and trips.
Key Legislation
- Health and Safety at Work (Northern Ireland) Order 1978 (legislation.gov.uk)
- Health and Safety at Work (Amendment) (Northern Ireland) Order 1998 (legislation.gov.uk)
- Management of Health and Safety at Work Regulations (Northern Ireland) 2000 (legislation.gov.uk)
- Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (Northern Ireland) 1997 (legislation.gov.uk)
- Reporting of Injuries, Diseases and Dangerous Occurrences (Amendment) Regulations (Northern Ireland) 2004 (legislation.gov.uk)
- The Management of Health and Safety at Work (Amendment) Regulations (Northern Ireland) 2006 (legislation.gov.uk)
- The Manual Handling Operations Regulations (Northern Ireland) 1992 (legislation.gov.uk)
Please note that these links are to the original legislation, visitors should verify for themselves whether legislation is in force or whether it has been amended or repealed by subsequent legislation.
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