Beyond TILE: MSK health and MSDs

Bridget Leathley looks at the key areas that need to be considered when assessing musculoskeletal risks in the workplace.

Musculoskeletal (MSK) health refers to the performance of the supporting and movement systems of the body, including bones, joints, muscles, tendons and adjacent connective tissues.

Musculoskeletal disorders (MSD) include a range of problems affecting MSK health, particularly the back, neck, shoulders, arms and wrists.

Until the turn of the century, MSDs were the highest self-reported cause of work-related ill-health in the UK. There was a downward trend from nearly 4 per cent of workers in the mid-nineties, to around 2 per cent by 1999 when MSD fell into second place behind work-related stress, anxiety and depression. The estimate for the year ending March 2025 is that 1.47 per cent of the workforce suffer from work-related MSD. The prevalence is higher in construction (2 per cent), and transportation and storage (1.8 per cent) industries, jobs which involve a significant amount of manual handling.

Simple risk assessment of MSK health: TILE

In the 1990s I was reading research papers that attempted to find a link between manual handling tasks and MSD. While the connection might seem obvious, the problem researchers had was the lack of a dose-response relationship. With a poison, generally the more you swallow, the worse the effect. Researchers had expected to find that the heavier the loads, or the more frequent the movements, the greater the reported ill-health.

But with manual handling, some people can manage heavy loads many times a day, while others suffer an injury moving a box of photocopy paper. Whether someone suffers an injury as a result of manual handling depends on multiple factors. In guidance L23, the Health and Safety Executive (HSE) summarises this with the acronym TILE (rearranged in some training as LITE). TILE is a reminder to consider the Task (how high, how far, how difficult), the Individuals involved (strength, ability, numbers needed), the Load (weight, texture, shape) and the Environment (floor surface, lighting, temperature).

If a task requires someone to twist and reach or bend at the same time, it puts more strain on the body. If the environment includes slopes or steps or slippery surfaces, someone might slip. If the load is hot or sticky, it is more difficult to hold it in the most comfortable position. All these factors make an injury more likely.  It’s a complicated picture.

Like personal protective equipment, training is near the bottom of the hierarchy of controls. It is important, but it shouldn’t be limited to “this is how you lift” for handlers. Everyone, including supervisors and managers, needs to learn to recognise risky aspects of manual handling tasks. There is no point training a handler to lift a clean 15kg box onto a trolley in a large classroom if their real-world task is to lift a 30kg barrel of waste up some dirty steps and tip it through 180° to empty into a skip. The managers or supervisors designing systems of work need to recognise that 30kg is too much for one person. A short-term alternative may be needed and in the long-term, the task and the environment need to be redesigned. For example, provide a smaller waste collection bin on wheels and replace the steps to the skip with a gentle slope which allows the bin to be pushed to the edge. A hatch in the bin could eliminate the need to turn it upside down.

Other risk assessment techniques

While some problems can be assessed using the simple TILE structure, other handling tasks need careful consideration. The HSE risk filter for lifting and lowering indicates where further assessment might be needed, depending on the weight of the load and the position to which the handler is lifting or lowering.

HSE provides more detailed risk assessment tools for different types of handling tasks. Depending on the task you can use:

• RAPP for pushing and pulling tasks
• ART for repetitive tasks
• Manual handling assessment charts - MAC for similar load weights across a shift, or V-MAC for variable load weights
• Manual handling risk assessment

Each tool provides a description of specific risk factors to consider for the type of handling task. For example, the required position of the hands when pushing or pulling trolleys and the frequency and force needed for repetitive tasks.

Using the relevant tool as part of your risk assessment will help you to identify what could be improved. You might change the load – can you have more, smaller items, or modify the grip on the load by using different packaging? You might change the task by redesigning work surfaces so they are height adjustable or organise storage so that more frequently used items are at waist height. Clearing unnecessary items from around the area where the handling task takes place enables people to use a better posture while handling. The tools also provide guidance on where anatomy and psychosocial factors can impact risk.

Anatomy and physiology

To carry out a thorough risk assessment of any manual handling task, it’s important to have a basic understanding of anatomy and physiology. Manual handling train‑the‑trainer courses - such as this one from RoSPA - include essential topics like spinal awareness and the principles of biomechanics.

Recognising how the musculoskeletal system responds to movement and load - and applying ergonomic principles - will help you to assess risks across different environments. It will also enable you to adapt handling methods to meet the needs of different individuals.

Psychosocial risk assessment

Risk assessment of MSK health must also consider the psychosocial hazards. For example, training will have no value if people don’t have control over the way they carry out tasks. They need to be able to delay or re-order some tasks, and when they believe something to be unsafe, to stop and ask for further support.

Studies have shown a link between stress and MSK pain, and between how people get on with their colleagues and the likelihood of an MSD. If you don’t feel you can ask a colleague for help, or you know your boss will shout at you if you don’t finish a job on time, you are more likely to attempt a job on your own. Payment systems and work demands can increase the risk. In one workplace, people working in pairs were only “on the clock” while a machine was running. If both workers paused to empty the waste, the machine would have to stop. So, they took it in turns to empty the waste, so the other worker could keep the clock ticking. They were strong people, but over time the repetition of this heavy manual handling task several times a day took its toll on their backs and shoulders. Repetitive, monotonous tasks, tight deadlines, high workloads and lack of job satisfaction all add to the risk of experiencing MSK pain.

Other causes of MSD

Manual handling is not the only workplace task presenting a risk to MSK health. People working on production lines, in assembly tasks or at a desk with a computer suffer when they hold the same posture for long periods (static posture), and when their workbenches or workstations don’t allow them to work in neutral/natural positions. The HSE report Work-related musculoskeletal disorders statistics in Great Britain 2025, published November 2025, still quotes the proportions of causes of work-related MSDs collected in 2012 (as data on causes is no longer analysed). At that time, 44 per cent of reported MSDs were attributed to manual handling, and a further 22 per cent due to working in awkward or tiring positions. Only 14 per cent of MSDs at that time were due to keyboard work.

Since 2012, the increase in hybrid and homeworking, along with the automation of some manual handling tasks (such as robots for picking and packing) is likely to have increased the proportion of MSD due to keyboard use. While standard DSE assessments will assess whether someone’s home computer-desk set-up promotes healthy posture, we need to expand the assessment to include the changes in how we work. The best control for limiting MSDs during DSE work is to move frequently. Getting to a desk in an office, and walking to meetings and the drinks machine naturally adds movement to the day. For me, a typical visit to a client can clock up 10,000 steps. A home office day, where you click from one meeting to the next without ever standing up can leave the body much more fatigued, stiff and aching if you don’t add some deliberate movement.

Training

Element 6 of the NEBOSH National General (NG2) syllabus covers musculoskeletal health, including work-related upper limb disorders (WRULD) and manual handling. RoSPA runs courses for people doing manual handling tasks, and for those training them.

We offer a range of NEBOSH training to help different people. If you’re new to the field, want an excellent foundation, or want to take the first steps to becoming a chartered safety and health practitioner, then a NEBOSH course is for you. Find out more here.