Health & Wellbeing
Health and wellbeing is now increasingly being recognised as more than a matter for individual attention – successful organisations have recognised that good health is a key enabler to good business. The health, safety and well-being of staff directly contributes to organisational success and poor workforce health has a high cost*.
Healthwork are able to offer comprehensive advice and information to help you, your family or your workforce stay fit and healthy. Please click on one of the headings on the right, to access numerous resources including tips on how to manage various medical conditions.For information on common aspects of health and wellbeing please choose from the menu below...
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Tel: 0161 831 9701
Fax: 0161 833 0643
You don’t have to wait until you’re signed off work to benefit from Occupational Health intervention. In fact, the sooner you are referred the quicker appropriate support can be mobilised including, for example, a referral for counselling treatment through your employer’s retained counselling service (if available). The conditions listed in this section can all lead to problems with accuracy, punctuality and attendance at work. Occupational Health could assist you to cope better at work by making recommendations on adjustments in your working hours, work duties and working environment.
When you are clinically depressed you may experience:
- Persistent low mood and be unable to derive enjoyment from the things that you would normally enjoy
- Frequent bouts of tearfulness
- Disturbed and unrefreshing sleep; not being able to get off and/or waking about two hours before your alarm clock is set to go off
- Loss of appetite and weight loss
- Weight gain because of comfort eating
- Reduced sex drive
- Lack of concentration and poor memory
- Difficulties making decisions
- Low motivation – even simple everyday tasks seem “too much”
- No motivation to socialise
- A general slowing down in movement and thoughtRestlessness and be very fidgety
- Hopelessness and guilt
- Preoccupation with negative thoughts
- The feeling that life isn’t worth living
Complete this simple online depression questionnaire to check if you have symptoms of clinical depression.
Depression can affect anybody even in the absence of any obvious underlying vulnerability. Don’t think of depression as a sign of weakness. As many as one in ten people will be suffering an episode of depression to some extent at any one time. This figure may be even higher as so many sufferers never report their symptoms to their doctor.
Past experiences influence the way you view the world around you now and how you react to life’s difficulties. Sometimes these experiences are buried deep in the back of your mind and are no longer within your conscious awareness. A course of counselling could help you identify and come to terms with past traumas.
Studies have shown that during depression some chemicals in the brain do not function properly. One such chemical is called serotonin. Antidepressants work by correcting these chemical imbalances.
The effect depression has on your mood, your thought process and your behaviour is very much interlinked. Holding unhelpful thoughts about yourself and negatively interpreting events around you will negatively impact on your mood. This in turn leads to negative and unhealthy behaviour such as withdrawing, or smoking and drinking too much. This then makes you feel worse about yourself and so continues the negative cycle. A form of counselling called Cognitive Behavioural Therapy, specifically addresses this cycle and helps you identify irrational and unhelpful thoughts and replace these with rational and positive thoughts.
For example, before an interview for a promotion at work you convince yourself you will fail and the worry affects your preparations.
Mind reading. You make unfounded assumptions about other’s beliefs.
For example, you think that when you fail your interview for promotion your manager will think you are a failure and your family will think you are stupid.
Catastrophising. You have a tendency to blow things out of proportion.
For example, because your family will think you are stupid for failing your interview for promotion your wife will leave you and your manager will have you sacked.
“Should” statements. This type of thinking could lead you to hold unrealistically high standards, which when you can’t meet makes you feel bad about yourself.
For example, at your age you should always do well in interviews and you should be getting that promotion at work.
“What if” statements. You’re always thinking “what if” something bad happens.
For example, you’re thinking if you turn up to the interview for promotion, “what if I clam up and forget how to answer the simplest question? What if they start laughing at me for not being able to answer any questions?”
You can see how this type of thinking can easily lead to unhealthy avoidance behaviour.
All or nothing thinking. Things are either black or white, with nothing in between.
For example, “Either I get that promotion at work or I’m a complete failure”
Labelling. You label yourself in a negative way.
For example, “I’m a worthless loser, why should they give me a promotion?”
What can you do to challenge unhelpful thinking patterns?
Once you’ve recognised an unhelpful thought, try asking yourself the following questions:
What evidence is this thought based on?
Do I have enough information to come to this conclusion?
What is the evidence against this conclusion?
Is there another way at looking at this situation?
How reliable is my prediction of the future?
Am I considering all possible outcomes?
If it was my friend/family member who had this thought, what would I be saying to him/her?
Challenging your negative thoughts takes practice. It’s useful to keep a journal and start off writing down all the unhelpful thoughts that you identify and then go through your responses to the above thought challenging questions. You will quickly realise that there are a few specific types of unhelpful thinking patterns that crop up again and again. With practice this process will help you learn to instinctively challenge these thoughts.
Commonly referred to as “baby blues” and affects the new mother after the birth of her baby. The symptoms of baby blues is short lived but when they persist you may be suffering from post natal depression. Symptoms can be delayed many months until after the birth. It is important to recognise early if a new mother is suffering with this condition so treatment can start as soon as possible. Untreated, there is a risk that the natural mother-child bonding process will not progress normally.
Click here for more information about post natal depression.
Bipolar disorder (manic depression). Classically, this condition is characterised by alternating low mood and very high mood or “manic” episodes. So called manic episodes (which are more likely to be referred to medically as hypomanic episodes depending on the severity of symptoms) can manifest as over-exuberance, over-confidence, and sometimes the individual loses their normal inhibitions. These episodes can be quite subtle. Telling signs are uncharacteristic risk taking behaviour, starting a number of grandiose schemes at the same time, spending sprees leading to debts, sexually uninhibited behaviour, and talking rapidly and flitting through a series of unrelated topics.
Click here for more information about bipolar disorder.
Things you can do for yourself:
- Exercise regularly; exercise releases chemicals in the brain called endorphins, which can help you to feel better
- Structure your day; don’t spend your day in bed or in front of the TV: try to maintain some form of normal routine
- Don’t drink excessively; alcohol is a depressant and reduces the benefits of treatment
- Maintain a health eating pattern and diet [links to article on diet and exercise]
- Look through our tips on sleep hygiene [links to article on sleep]
- Look through the above tips on challenging unhelpful thoughts
- The above strategies may be sufficient, in combination with self-help or short-term talking therapy, if you have mild depression (be guided by your GP).
For more severe cases, a combination of talking therapy (usually Cognitive Behavioural Therapy) and antidepressant treatment may be required.
Antidepressants are not addictive. Their beneficial effects can be delayed by 2 to 4 weeks from when you start treatment. If the treatment remains ineffective after this period, your GP may increase the dose of the tablet or replace it with an alternative. You may be advised to remain on antidepressant treatment for between 6 to 12 months, even if you feel better before this time period. If you have had more than one episode of depression you may have to remain on treatment for longer.
Your anxiety may be focused on a very specific situation, e.g. public speaking, and not affect your life in any other way. Alternatively your anxiety may be less specific in the situation in which it arises or even present all the time (Generalised Anxiety Disorder). Anxiety symptoms are worse in some settings, for example in public places. You may feel “boxed in” in such situations and experience a “panic attack”, which is an exaggerated “fight or flight” reaction (see below).
Enduring anxiety encourages avoidance behaviour and may render you virtually house-bound in extreme cases.
When you have an anxiety disorder, apart from feelings of persistent restlessness and worry, you may experience the following physical symptoms:
- Muscle tightness particularly around the neck
- Chest pains
- Bowel disturbances
- Breathlessness (hyperventilation)
- Jaw pain and dental problems from teeth grinding
An untreated, or under-treated, over-active thyroid gland is one of the recognised causes of anxiety.
If you’re facing a stressful life situation then try some simple stress management techniques. There are different ways to cope with stress and they all require either the stressor to change or for you to change.
Think of the 4 A’s:
Alter the stressor. If the stressor cannot be eliminated be willing to compromise and find a happy middle ground; try being assertive if the stressor happens to be someone’s behaviour towards you; try time management techniques if you are experiencing
Adapt to the stressor. If you can’t change the stressor then change your expectations or attitude towards it; try a technique called re-framing where you look for constructive opportunities or hidden benefits in something that you have hitherto considered a stressful situation; look at the bigger picture – how important is this issue in the grander scheme of things?
Accept the stressor. You can’t control what is beyond your control: learn to accept the situation, share your feelings, and focus on healthy activities to free yourself from negative energy.
Mind Infoline - Tel: 0300 123 3393. Provides information and advice on where to get help for a range of emotional problems.
Shout - Women’s bi-monthly newsletter on self-harm produced by women who have experience of self-harm.
NHS Choices – living with depression -Plenty of information and resource material on depression.
NHS Choices – anxiety - Excellent resource centre for easy to understand information about anxiety.
Self-help booklet Useful information and reflective exercises for those experiencing self-harm thoughts.
Anger Management - Visit this site for general advice about anger management if you are feeling that your irritability is starting to get out of control.
National Debtline - Tel: 0808 808 4000. Helpline providing free and independent advice on how to deal with debt problems.
In this section we can provide you valuable information on:
- Healthy eating
- Useful links
A healthy diet can reduce your risk of illnesses such as heart disease, cancer, and diabetes, as well increase your energy, stabilize your weight, and boost your mood.
The following easy guidelines will enable you to expand your range of nutritious food choices and create an enjoyable, healthy diet that works for you.
In our fast food culture, maintaining a healthy diet and a healthy weight can be challenging. Adding to the difficulty is the abundance of fad diets and “quick-fix” plans that tempt and confuse us, and ultimately fail. If you’ve tried and failed to lose weight before, you may believe that it’s just too difficult or that diets don’t work for you.
But there are plenty of small but powerful changes you can make that will help you to achieve lasting weight loss success. The key is to create a plan that provides plenty of enjoyable choices, avoid common dieting pitfalls, and learn how to develop a healthier, more satisfying relationship with food.
The key to successful, healthy weight loss
The formula is a simple one: if you eat more calories than you burn then you gain weight. If you eat fewer calories than you burn, you lose weight.
Since 3,500 calories equals about 1 pound of fat, if you cut 500 calories from your typical diet each day, you'll lose approximately 1 pound a week (500 calories x 7 days = 3,500 calories). So why is weight loss so hard?
Miracle diets don’t work. There is no easy, quick-fix. Adopting a healthy diet is a lifestyle choice – like quitting smoking. The benefits are you achieve and maintain your target weight, and you reduce your risk of obesity related disease. You also look better and feel better about yourself. But you need to exercise too. Remember the formula above? The key is toreduce calories coming and increase calories burnt.
Think lifestyle change, not short-term diet. Long term weight maintenance is not something that a “quick-fix” diet can achieve. Instead, think about weight loss as a permanent lifestyle change. Various popular diets can help to jumpstart your weight loss, but permanent changes in your lifestyle and food choices are what will work in the long run.
Have people rooting for you. Rope in some social support, including family and friends. Programmes like Weight Watchers use group support to impact weight loss and lifelong healthy eating.
Go steady. Aim to lose 1 to 2 pounds a week to ensure healthy weight loss. Losing weight too fast can make you feel unwell.
Set goals. Whether it’s wanting to fit into an old dress or suit, or simply wanting to feel fitter and healthier, give yourself something to aim for.
Track your progress. Weigh yourself regularly so you can continually see the fruits of your efforts.
Try different foods and vary what you eat for meals. Experiment with new and exotic (and healthy) foods. It’s important that the food you eat is appealing to you so that you can stick with it on a long-term basis. If one diet plan doesn’t work, then try another one. Any diet plan is a good one as long as it reduces your calorie intake and is healthy for your heart (low in saturated fat and cholesterol).
Your diet is too restrictive. Diets that cut out entire groups of food, such as carbohydrates or fat, are simply impractical and unhealthy. These diets are unbalanced and can lead to health problems arising from a lack of essential nutrients. The key is moderation not elimination.
You can’t keep the weight off. Diets that severely cut calories, restrict certain foods, or rely on ready-made meals might work in the short term. However, these diets can’t realistically be sustained. The weight quickly comes back on as you struggle to keep up with the diets’ rigid and rigorous programme.
When you drastically restrict your food intake, your metabolism will temporarily slow down. Once you start eating normally, you’ll gain weight until your metabolism bounces back! Another reason why starvation or “fasting” diets are counterproductive.
Your diet is too expensive. Special shakes, meals, and programmes may be cost-prohibitive and less practical for long-term weight loss and healthy weight maintenance.
We don’t always eatsimply to satisfy hunger. If we did, no one would be overweight. All too often, we turn to food for comfort and stress relief. When this happens, we frequently pack on pounds.
To start, consider how and when you eat. Do you eat only when you are hungry, or do you reach for a snack while watching TV? Do you eat when you’re stressed or bored? When you’re lonely? To reward yourself?
Once you’ve identified your emotional eating tendencies, you can work towards replacing unhealthy emotional eating habits with healthier alternatives.
Using food as a relaxant. Find other soothing ways to reward yourself and unwind. Relax with a book. Soak in a hot bath. Or go to the gym.
Using food as a energy “pick-me-up”. Find other mid-afternoon pick-me-ups. Try taking a walk outdoors, listening to music, or doing some quick stretches.
Using food as.....well, company. Call a friend. Or go to the gym, where you’ll not only burn calories but also make new friends. Why not take up a fun activity such as salsa dancing?
Using food as a stress-buster. Find healthier ways to calm yourself. Try exercise, yoga, meditation, or breathing exercises. See our article on stress management.
Getting the balance right
To lose weight, you have to eat fewer calories. But that doesn’t necessarily mean you have to eat less food. You can fill up while on a diet, as long as you choose your foods wisely. The key is to add the types of food that can keep you feeling satisfied and full, without packing on the pounds.
The Eatwell Plate
The eatwell plate shows the different types of food we need to eat - and in what proportions - to have a well balanced and healthy diet.
It's a good idea to try to get this balance right every day, but you don't need to do it at every meal. And you might find it easier to get the balance right over a longer period, say a week.
Eating healthily is about about eating the right amount of food for your energy needs. In England, most adults are either overweight or obese. This means many of us are eating more than we need, and should eat and drink fewer calories in order to lose weight.
Based on the eatwell plate, you should try to eat:
- Plenty of fruit and vegetables
Did you know that we should be eating at least five portions of a variety of fruit and veg every day.
- Plenty of potatoes, bread, rice, pasta and other starchy foods
Choose wholegrain varieties whenever you can.
- Some milk and dairy foods
- Some meat, fish, eggs, beans and other non-dairy sources of protein
Pulses are a good source of protein.
- Just a small amount of foods and drinks high in fat and/or sugar
See – not saying you need to avoid fat or sugar completely!
Try to choose options that are lower in salt when you can.
High fibre foods not only keep you regular but are also very filling because of their high volume. They take longer to digest and so make you feel fuller for longer.
Food that is high in fibre include:
- Fruits and vegetables
- Beans and pulses
- Whole grains, e.g. whole wheat pasta, brown bread, brown rice and oatmeal.
- Changing your eating habits
Start the day with breakfast. A healthy breakfast will stimulate your metabolism and will stave off hunger until lunchtime.
Serve yourself smaller portions. This can be difficult initially. Try using small plates, bowls, and cups to discipline you. A well balanced plate will still make you feel full.
Plan your lunchtime meals. You won’t then be tempted to or forced to grab a take away meal (or a liquid lunch!).
Pack healthy snacks. Put some fruit in your lunch pack or low calorie snacks.
Cook your own meals. Cooking meals at home allows you to control both portion size and what goes in to the food.
Plan your weekly grocery list. Create a shopping list containing the healthy food options recommended here and stick to it. Inspect the nutritional and calorific content of the food you buy. This information is easy to find on modern packaging.Remember to read it carefully; sometimes the information refers to part packages or single portions.
Healthy lifestyle changes
A healthy diet is only part of your strategy to eat and live healthily. Don’t forget other lifestyle changes.
Get plenty of sleep. Lack of sleep has been shown to have a direct link to hunger, overeating, and weight gain. When exhausted you’re more likely to be tempted by unhealthy “pick-me-up” foods. Aim for around 8 hours of quality sleep a night.
Get plenty of exercise. Exercise burns calories (remember the calorie formula above). See our article on exercise for useful tips.
Drink more water. You can easily reduce your daily calorie intake by drinking plenty of water. Aim to drink Thirst can also be confused with hunger, so by drinking water, you may avoid consuming extra calories.
Water makes up about 60 percent of your body weight. Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues.
There are many reasons why doctors, dietitians, and trainers recommend drinking plenty of water when you are trying to lose weight. The most important are listed for you below.
- Sometimes thirst is mistaken for hunger. The next time you feel hungry, have a glass of water and wait twenty minutes. You may find that you’re not hungry any more.
- Water keeps your body clean. Losing weight and burning fat create by-products in the body that need to be eliminated. In order to do so, the body needs a healthy supply of water.
- Cold water burns calories. In no way should you assume that drinking ice water all the time will cause you to magically lose weight fast, but drinking cold water helps burn a few extra calories here and there because the body has to work harder to absorb it.
- You sweat when you work out. When you work out, you will lose a lot of water through sweating and respiration. That water needs to be replaced for you to maintain your energy levels and keep your body working
Lack of water can lead to dehydration, a condition that occurs when you don't have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired.
Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish it.
The adequate intake amount of water for men is roughly 3 litres a day. The amount for women is 2.2 litres a day.
As a general rule of thumb – aim to drink 8 glasses of water per day. Sip the water slowly throughout the day.
Exercise reduces the risk of developing heart disease, stroke, high blood pressure and type 2 diabetes.
It’s also has a beneficial effect on your emotional wellbeing. Exercise is routinely recommended to people complaining of low mood, stress and anxiety.
You should aim for 30 minutes of moderate intensity physical activity on at least 5 days of the week. You don’t have to do the 30 minutes all at once – you can break up your daily exercise into shorter bursts of activity over the full day.
You don’t have to go to the gym to exercise. Any activity that will get you warm and slightly out of breath is all it takes. Consider, for example:
- Walking or cycling to work and local shops
- Doing the housework and gardening at a brisker rate
- Taking up dancing
- Take out a fitness based DVD or interactive console game
- Go for a walk during your work lunch break
A useful device to get you started and keep you motivated is a pedometer. This inexpensive little gadget counts the number of steps that you take. About 30 minutes of brisk walking is equivalent to around 3,000 steps. So include an additional 3,000 steps to your usual daily step count. You can build up gradually to this figure. The aim is for 10,000 steps per day in total to keep fit and healthy.
You may need to see your GP before embarking on an exercise programme if:
- You have a heart condition or have had a stroke
- You’re experiencing chest pains or are very breathless after mild physical exertion
- You suffer from dizziness or black outs
- You have a joint or back problem that you’re worried about.
NHS Live well Healthy eating - Information, resources and tools for healthy eating.
British Heart Foundation - Guidance on healthy eating for a healthy heart.
British Nutrition Foundation - Advice and tips on putting healthy eating into practice.
NHS Live well Physical activity - Downloadable guidance notes on physical exercise. Plenty of useful tips, tools and videos.
- Illicit drugs
If alcohol is drunk in safe amounts it can be relaxing and enjoyable, although you should be cautious drinking any amount of alcohol if you have certain liver diseases or are if you are taking certain prescribed medication. If you are not sure, ask your GP or pharmacist.
The safe recommended guidelines for drinking alcohol advise that you do not regularly drink more than:
- 2 units on average per day for both men and women (i.e. 14 units per week)
Use this alcohol unit calculator to find out if you’re drinking within the recommended guidelines. CLICK HERE
Smoking is a major risk factor for at least 20 diseases including heart and peripheral vascular disease, strokes, chronic bronchitis and COPD, and at least 80% of lung cancers.
Although nicotine itself is not carcinogenic, tobacco smoke contains over 200 other compounds that are potential carcinogens (a carcinogen is something that can cause cancer) and smoking itself is the greatest single risk factor for lung cancer. Cigarette smoking significantly contributes to several other cancers of the nose, mouth, throat, gullet and stomach.
Apart from its well publicised health effects on the smoker, smoking:
- Harms your unborn baby in pregnancy
- Harms those around you through passively inhaling smoke
- Has a serious financial impact on the smoker
- Diminishes sense of smell
- Diminishes sense of taste
- Prematurely ages skin
- Stains skin and furniture
Fill in this short online smoking questionnaire to find out if you have an addiction to nicotine and for simple tips to quit.
The health benefits of giving up smoking
Giving up smoking will help avoid most of the risks of developing cancer, even in middle age. Giving up smoking before middle age can prevent 90 per cent of the health risks associated with smoking. These benefits apply to giving up cigarettes, cigars, pipe and chewing tobacco.
When giving up, your body will go through several changes:
|20 minutes||Blood pressure and pulse rate return to normal. Circulation improves, especially to hand and feet.|
|8 hours||Blood oxygen levels increase to normal, and your chances of having a heart attack start to fall.|
|24 hours||Carbon monoxide leaves the body. The lungs start to clear out mucus and debris|
|48 hours||Your body is now nicotine-free. Your sense of taste and smell begin to improve.|
|72 hours||Breathing is easier, and your energy levels increase|
|2-12 weeks||Circulation improves throughout the body. Walking and exercising is getting easier.|
|3-9 months||Breathing problems, coughing, shortness of breath and wheezing improve. Lung efficiency increases by 5-10 per cent.|
|5 years||Risk of having a heart attack falls to about half that of a smoker.|
|10 years||Risk of lung cancer falls to around half that of a smoker. Risk of a heart attack falls to about the same as someone who has never smoked.|
Source: Department of Health, 2005, Giving up for life
Most smokers giving up will experience some temporary withdrawal symptoms. These are a result of the body ridding itself of toxins. These symptoms include irritability, cravings, headaches and hunger.
Speak to your GP or the Practice Nurse at your surgery. There are a number of NHS initiatives running to help smokers quit.
The support you will receive will consist of any combination of nicotine replacement therapy (such as nicotine patches and gum), specific prescribed medication such as Zyban or Champix. You may be referred to a smoking cessation clinic where you will receive ongoing support.
Look out for Occupational Health run smoking cessation activities.
The use of illicit drugs is common in the UK. There is estimated to be 1.6 million regular users of illicit drugs amongst adults aged between 16 and 59 years.
After cigarettes and alcohol, cannabis is by far the commonest used drug – almost 1 in 20 adults aged between 16 and 59 years have used the drug in the last month. Young adults aged between 16 and 24 years are more likely to be users than the older age groups.
The most common cause of death relating to misuse of illicit drugs is accidental overdoses. The majority of deaths are due to heroin or morphine, followed by methadone, benzodiazepines and cocaine. It is less easy to record the number of deaths amongst illicit drug users relating to blood borne infection, violent assaults and suicides.
Warning Signs of Commonly Abused Drugs
Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.
Depressants (including morphine): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness.
Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
Inhalants (glues, aerosols): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability.
Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behaviour including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.
Speak to your GP. Confide in the people you trust and who care about you. There are NHS clinics for drug addictions that you can access through your GP.
In the workplace, ask your manager for an Occupational Health referral.
Drinkaware - Excellent advice on alcohol awareness
NHS Live well - Excellent resource giving information, real life case experiences and details of support available.
Beating addictions - Provides general advice about a range of addictions.
Addaction - National charity that provides a range of services to help transform the lives of people affected by drug and alcohol problems. Details of local services available on the website.
Alcoholics anonymous - Support specifically for alcohol addiction.
Smoke free - NHS resource for stopping smoking.
In this article we discuss:
- Sleep hygiene tips
- Sleep and shift working
It is difficult to know how to define “enough” sleep. Different people need different amounts of sleep, depending for example on age and activity levels. Generally speaking, most adults need about 6 to 8 hours sleep per night.
It is common to experience difficulties in sleeping during stressful times, for example during exams. A few nights of disturbed sleep is unlikely to lead to serious health problems. Normally when these stressful periods pass, your sleep pattern is restored and your body recovers. But the sleeplessness may sometimes persist.
Causes of insomnia
The Insomnia Trap
Something on your mind. You can’t sleep because your mind persistently wanders to some worry or difficulty that is preying on your mind. You are restless, irritable and fidgety even while lying in bed.
You worry about not sleeping. You are now dreading bedtime. Before you even get into bed you become anxious that you won’t be able to sleep. You worry about the consequences of not sleeping so much that this in itself becomes a barrier to sleep.
Your sleep time routine is completely disrupted. You avoid going to bed and stay up later and later – not relaxing but trying to occupy yourself so that you are distracted from your worries. You resort to napping as and when you can during the day.
The most common causes of insomnia are:
- Distraction by noise, inappropriate lighting levels, uncomfortable temperature, uncomfortable bed
- Can’t get comfortable because of a chronic medical condition causing physical pain, breathlessness or involuntary movements (e.g. “restless legs”)
- Taking vigorous exercise just before bedtime
- Eating a large meal just before bedtime
- Too much caffeine during the day and evening (coffee, tea, drinking chocolate)
- Napping late in the day
- Some medication, e.g. water tablets; and non-prescribed medication such as cold remedy decongestants
- Depression or anxiety
- Jet lag or shift work
Some people have so called “delayed sleep phase”, which means that their body clock is out of phase with the normal sleep/wake cycle. Another less common cause for insomnia is sleep apnoea, when you momentarily stop breathing during the night. The sufferer may not always be aware that this is happening and these individuals are often marched into the GP surgery by their bed partners!
In many cases, there is no identifiable reason for the insomnia (so called primary insomnia).
Effects of insomnia
Insomnia can affect your energy levels during the day and mood. It can affect your health, work performance and quality of life. You are more likely to be:
- Depressed and anxious
- Tired during the day
- Unable to concentrate on a task
- Suffering symptoms of headache, visual fatigue and bowel upset
- At risk of an accident or making errors at work
- At risk of developing illnesses such as heart disease and high blood pressure.
There are some well established tips for sleeping, referred to as sleep hygiene techniques.
They are (taken from Patient.co.uk):
Reduce caffeine. Do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the entire day has helped.
Do not smoke within six hours before bedtime.
Do not drink alcohol within six hours before bedtime.
Do not have a heavy meal just before bedtime (although a light snack may be helpful).
Do not do any strenuous exercise within four hours of bedtime (but exercising earlier in the day is helpful).
Body rhythms. Try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore:
- No matter how tired you are, do not sleep or nap during the day.
- It is best to go to bed only when sleepy-tired in the late evening.
- Switch the light out as soon as you get into bed.
- Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week.
The bedroom should be a quiet, relaxing place to sleep:
- It should not be too hot, cold, or noisy.
- Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.
- Make sure the bedroom is dark with good curtains to stop early morning sunlight.
- Don't use the bedroom for activities such as work, eating or television.
- Consider changing your bed if it is old, or not comfortable.
- Hide your alarm clock under your bed. Many people will clock watch and this does not help you to get off to sleep.
Mood and atmosphere. Try to relax and wind down with a routine before going to bed. For example:
- A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening.
Do not do anything that is mentally demanding within 90 minutes of going to bed - such as studying.
Go to bed when sleepy-tired.
Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.
Shift work, and particularly rotating 24 hour shift patterns, disrupts the external cues that the internal clock depends on to function properly. Some people are better than others at adapting to this disruption. But even if you have worked rotating shifts for many years, as you get older you may find it increasingly difficult to continue to adapt. You may find it is becoming more difficult to sleep, leading to increased fatigue during waking hours.
Some medical conditions can make it very difficult, or even unwise, to continue working 24 hour rotating shifts. If your shift pattern includes night working then you are entitled to a free health assessment. Ask your line manager for details.
Health problems associated with working shifts include peptic ulcers, cardiovascular disease, chronic fatigue, excessive sleepiness and difficulty sleeping. Shift workers also tend to be more overweight due to poor eating habits and lack of exercise. They also have a higher divorce rate, worse rates of substance abuse and depression.
Coping tips for shift workers
In addition to the general strategies that constitute good sleep hygiene (see above) the following tips may be helpful:
Sleep schedule. Have a short sleep before your first night shift. When coming off nights have a short sleep and go to bed earlier that night. Alter the times you sleep if necessary until you find the most effective sleep schedule. Aim for about 6 to 8 hours of sleep. Once you’ve identified a sleep schedule that works for you try to stick to it.
Sleep environment. Trying to sleep during the day can be a challenge. You need to block out as best as you can all external lights and noise. Use heavily lined curtains, eyeshades and ear plugs if you have to. Make sure family and friends know you are not to be disturbed during your sleep schedule. Plan your family and leisure time around your sleep schedule.
Adapting the internal clock. The internal body clock relies on a number of external cues to put you in alert or sleepy mode. You can re-set some cues to make it easier for you to adapt to shift work. Exercise is a cue to put you in alert mode. Why not start your new “day” with a brisk walk or jog? Additionally, time your main meals to match the new “day”. To avoid drowsiness, trying eating regular light meals/snacks rather than a single heavy meal during your working shift. Ensure that you are eating healthily weight gain and digestive problems are common in shift workers because of unhealthy diets.
Commuting to work. Consider using public transport (when practical) to commute to work or share driving if possible. Make sure you are alert before driving – do some exercise beforehand.
Staying alert at work. Try exercising before coming to work and take regular walks through the working shift. Regular light meals are less sleep inducing than a single large meal. Don’t rely on cigarettes and excessive amounts of coffee. Fill long breaks in the working shift with something stimulating to do – perhaps some exercise or puzzles. There is currently a lot of interest in the use of “restorative naps” during shift work but depending on the nature of your work (lone working, critical safety work, etc) this isn’t always practical. Discuss this with your line manager.
Discuss any persisting problems of sleeplessness with your GP. If your work is becoming affected ask to be referred to Occupational Health.
Your local pharmacist may be able to suggest simple “over-the-counter” remedies to try to help you sleep. Make sure you make the pharmacist aware of any medicines you may already be taking and any existing health problems.
Your GP will investigate and treat you for any underlying medical problem causing your sleeplessness. This may involve a referral to a sleep clinic.
Your GP may recommend a short course of sleeping tablets but you will be discouraged from relying on these over a longer period. You may be offered an antidepressant if you have symptoms of depression or anxiety. You may also be referred for talking therapy for strategies to reduce your anxiety and break out of the insomnia trap.
NHS Live well Insomnia - Extensive resource and advice on managing insomnia.
Northumberland, Tyne and Wear NHS - Self-help information on sleeping problems, which you can download as a pamphlet or as an audio file.
HSE advice for shift - The HSE promote safe work practices and this article gives general guidance on coping mechanisms for shift workers.
Often, the problem is recurring, with most people experiencing episodes of pain in between periods of good health. Individual episodes of low back pain tend to be short-lived and get better on their own.
Occupational health nurses and doctors frequently deal with low back pain. Although many people assume that this means low back pain is caused by work, the scientific evidence is unclear. Someone working in a heavy manual job is more likely to report back pain to their GP and manager because it is more likely to stop them working. But many people who perform lighter duties at work, and even those who are not working, also experience back pain.
Most muscles in the body will relax completely when they are not being used, but the muscles in the neck are permanently tensed in order to support the head. People over 50 are more likely to report neck pain but it can develop at any age. The cause is usually related to posture, e.g. slouching, sleeping in an awkward position or working at a computer for long periods of time without a break.
Neck pain can also develop as the result of an accident. Perhaps the best known is whiplash; an injury sustained as a result of the head being violently thrown forward and back in a car accident.
Neck pain is rarely the result of a serious injury and will often lessen after a few days. If you are suffering from neck pain, try to keep moving and maintain your normal routine as best you can. Over-the-counter painkillers may also help.
This term applies to general age-related wear and tear in your neck. Some doctors may refer to it as osteoarthritis in the neck or spinal degeneration. These changes are seen on X-rays. The X-ray has significant limitations as a medical test in neck pain. The extent of wear and tear damage seen on X-ray often bears little resemblance to the extent of pain reported. Most people over the age of 30 years, whether they have neck pain or not, will have signs of wear and tear in the cervical spine. You would expect to see age-related changes.
Trauma to the bones or disc in the cervical spinal can lead to accelerated wear and tear damage.
Wear and tear changes in the cervical spine can lead to pinching of the nerves arising in the neck.
Common symptoms of cervical spondylosis include:
- Pain and stiffness in the neck
- Shoulder, arm or chest pain
- Pins and needles or numbness in your arms, hands, legs or feet
- Weakness in the arms or legs
You might experience recurrent symptoms with cervical spondylosis and each episode is likely to respond well to the simple combined measure of keeping mobile and taking simple painkillers.
If home exercises and simple painkillers don’t settle your symptoms then you may be referred for physiotherapy. Muscle relaxants might be required if there is substantial muscle spasm. More severe cases may require a spinal injection or even surgery.
These red flag signs include:
- A high temperature (fever) of 38C (100F) or above
- Unexplained weight loss
- Constant back pain that does not ease after lying down or resting
- Pain that travels to your chest or that is high up in your back
- Pain down your legs and below the knees
- A recent trauma or injury to your back
- Loss of bladder control
- Inability to pass urine
- Loss of bowel control
- Numbness around your genitals, buttocks or back passage
If you have any of the signs or symptoms listed above, contact your GP immediately. You should also seek medical advice if you are having back pain and:
- You are under 20 or over 55 years old
- You have taken steroids for a few months
- You misuse drugs
- You have or have had cancer
- You have a severely weakened immune system
- Also contact your GP if your symptoms fail to improve within three days or you have persistent pain that lasts longer than six weeks.
Back sprain may occur from a fall. Back muscles may not react quickly enough during a fall or accident and fail to keep the spine within its normal range of motion, which may result in overstretched or torn ligaments.
A slipped disc is in fact not a very common cause of back pain.
The discs are protective, circular pads of cartilage that lie between the bones of your spine (vertebrae) and cushion the vertebrae. The outer casing is a tough and fibrous case; this casing contains a softer gel.
A slipped disc occurs when the outer part of a disc ruptures and allows the gel inside to bulge outwards from between the vertebrae. The damaged disc can put pressure on your whole spinal cord or on a single nerve fibre. This means that a slipped disc can cause pain both around the area of the bulge or anywhere along the area controlled by an affected nerve.
A slipped disc occurs most frequently in your lower back. It is very uncommon in the thoracic or middle back. A disc may rupture because of severe trauma and wear and tear damage.
Symptoms of a slipped disc
Slipped discs occur most often in your lower back. The main symptoms of a slipped disc in this region are sudden, severe back pain, muscle spasm and sciatica.
Sciatica is pain, numbness, weakness, or tingling that extends down the sciatic nerve that runs from your lower spine through each buttock and leg. Usually the pain is only on one side. The pain is often made worse by moving, coughing or straining.
Occassionally a slipped disc can affect your bladder and/or bowel control. These symptoms inlcude:
- Difficulty passing or controlling urine
- Altered sensation around your back passage or genitals
- Numbness, pins and needles or weakness in both legs
- Unsteadiness on your feet
Any of these symptoms could suggest a medical emergency and you should seek medical advice urgently.
Diagnosing a slipped disc
The diagnosis is suspected from your description of any pain you are experiencing, along with a physical examination of your back, legs and feet to identify any nerve problems.
If it is suspected that a slipped disc is the cause of symptoms in your leg(s) and is not settled within six weeks to three months then an MRI scan of your spine may be arranged.
In 90% of cases the pain from a slipped disc gets better on its own and does not require an MRI and/or surgery. However, the healing process may take some time. For most people the condition gets a lot better within about six weeks.
Current advice is to try to remain active once the most acute pain in the leg has passed. Take over-the-counter painkillers if necessary (taking advice from your GP or pharmacist). Staying as active as possible will help relieve symptoms even if you are in a lot of pain. It is advised that you continue to work, or return to work as soon as possible.
Your GP will advise if stronger painkillers are necessary. You may be referred for physiotherapy to help you keep mobile and active.
In the past, it was thought the best cure for back pain was to rest. We now know that rest can be harmful as it allows your muscles to weaken, therefore delaying recovery. Staying mobile and keeping active is important for your recovery. Try not to let back pain interfere with your daily routine too much and return to work as soon as possible.
If back pain is so severe that it begins interfering with your daily activities, medication could be the next step. It is recommended that you first try over-the-counter medication such as paracetamol. If that doesn't provide sufficient relief, try ibuprofen. In either case, make sure you are taking the painkillers as regularly as the dosage information recommends.
Don't wait until your back pain is very bad. Speak to your GP or pharmacist.
Manual therapy includes treatment from a physiotherapist, a massage therapist and a chiropractor.
Your GP and the Occupational Health service can guide you to through the choices.
These practitioners will be able to advise on stretching routines or exercises you should be doing to keep your back muscles strong. As well as exercise, the treatment you may receive includes:
These practitioners usually liaise with your GP and advise when further medical, or surgical, input may be required.
If you are in the middle of experiencing an episode of back pain, some gentle stretches can help ease any discomfort and will help strengthen the muscles in your back.
BackCare, the charity for healthier backs, has produced a leaflet on stretches for spinal mobility that should be performed daily. You can find this leaflet on the BackCare website.
As well as stretching, research shows that exercise can be effective in reducing back pain.
The following sites give guidance on appropriate back exercises:
Big back pain
NHS Live well - Back exercise
Keeping your back strong
Strengthening your back through exercise is one of the best ways to keep back pain at bay. It can also be very helpful in treating back pain.
Choose a low-impact, gentle exercises. Yoga and pilates are very good for improving flexibility and strengthening core back muscles. You can then move on to more energetic exercise once your back pain settles.
See our article on exercise for useful tips.
Stretching is another key way of strengthening your back.
Lifting can strain your back and lifting badly can lead to injury. Follow these simple tips to avoid damaging your back.
Sitting in the wrong position can cause or aggravate back pain. Try to follow these simple tips to combat poor sitting habits:
Sit up with your back straight and your shoulders down and back, elbows relaxed at your sides. Your buttocks should touch the back of your chair.
- Avoid crossing your legs. This weakens your core muscles and can lead to stiffness in your low back and pelvic area.
- Your feet should be firmly on the floor, but if it's more comfortable, use a footrest.
- Your thighs should be at right angles to your body or sloping slightly down.
- Rest your elbows and arms on your chair's armrests or desk, keeping your shoulders relaxed.
- When sitting in a chair that rolls and pivots, don't twist at the waist while sitting. Instead, turn your whole body.
- Don't sit in one position for long stretches of time. Get up and move around as frequently as practicable. Don't forget to stretch.
- When standing up, move to the front of the seat of your chair. Stand up by straightening your legs. Avoid bending forward at your waist.
Display Screen Equipment (DSE) users can experience postural related back and neck pain. Ask the Health and Safety officer to help you to set up your workstation correctly. Here are some general tips on how your workstation should be configured:
- Your keyboard should be directly in front of you. A keyboard that is off-centre can cause bad posture.
- Turn your chair sideways to check that your elbow is level with the spacebar for the correct height.
- If your keyboard is at the proper height, you should be able to keep your wrists straight while typing.
- A palm or wrist support can help during rest periods from using the keyboard. Place the support under your palms, not your wrists.
- Your mouse should be close to your keyboard. You should be able to keep your wrist straight, shoulders relaxed and elbows by your side while using it.
- If you need to look back and forth between your monitor and documents, place your hard copy in such a way so as to avoid twisting your neck.
- Consider a document holder, which should be placed close to and at the same height as the screen.
- Place your phone close to you to avoid repetitive reaching.
- Avoid cradling the phone between your ear and shoulder as this can cause neck pain and stiffness. Consider a headset or speaker phone.
You may be better able to continue work with back pain if your job is sedentary and permits you to alter your posture regularly. But some of us are in jobs where we can’t avoid activity that is particularly difficult to perform with back pain. Such occupations may include nursing, construction and factory work. These workers are therefore more likely to report back pain to their managers and require sickness absence from work if alternative duties are not available.
A number of job factors can contribute to making it difficult to carry on working with back pain. For example:
Force. Exerting too much force on your back, such as by lifting or moving heavy objects.
Repetition. Repeating certain movements can lead to muscle fatigue or injury, particularly if you're stretching to the limit of your range of motion or using awkward body positioning.
Posture. Slouching exaggerates your back's natural curves, which can lead to muscle fatigue and injury. Maintaining one posture for prolonged periods without moving to stretch may worsen your symptoms of back pain.
Stress. Pressure at work can increase your stress level and lead to muscle tension and tightness, which can worsen back pain.
What can I do to avoid back pain at work?
You can take steps to prevent back pain and injuries at work.
Exercise. Build into your normal routine an exercise programme and maintain a healthy weight. See our article on diet and exercise [links to diet and exercise page].
Regularly alter your posture. Avoid standing or sitting for prolonged periods at work if possible. Alter your posture regularly between sitting, standing and walking. To promote good posture when sitting, choose a chair that allows you to rest both feet flat on the floor while keeping your knees level with your hips. If necessary, prop your feet with a foot stool. Make sure the curve at the bottom of your back is supported by the chair’s lumbar support or try a small cushion.
The workplace Health and Safety advisor will advise you on how to best configure your chair and desk. Ask that the workstation is reassessed if, for example, you develop any discomfort in your back, neck or arms.
Minimize hazards. Clear the work floor space of slip and trip hazards. Consider wearing low-heeled shoes with nonslip soles.
Lift properly. Make sure that you have had training in good manual handling techniques. See here for tips. When lifting and carrying a heavy object, lift with your knees and tighten your core muscles. Hold the object close to your body and maintain the natural curve of your back. If an object is too heavy to lift safely, find someone to help you. Use lifting devices to help you lift loads and a trolley to transport heavy loads. Separate a large load into smaller more manageable loads. Make sure you’re able to get a good grip on the load and that the load is stable.
Modify repetitive tasks. Think about how you can modify repetitive tasks at work to reduce physical demands on your body. Avoid unnecessarily repeating bending, twisting and reaching manoeuvres. If possible carry out a variety of different tasks during the working day.
Address stress. Stress can make your muscles tense, affecting your posture. Use positive coping mechanisms to deal with stress.
Advice for managing back pain at work
Discuss your back pain with your GP. An extensive study by the Faculty of Occupational Medicine has resulted in the development of a guidance document advising on back pain and work.
This study noted that in the management of back pain:
Risks for low back pain
Low back pain is a common problem that affects 60-80% of adults.
Low back pain is often a recurring problem.
Physical work may be a factor in developing low back pain but it is not the most important factor.
The only strong indicator that a person is at risk of low back pain is if they have experienced it before in the past.
Diagnosis and management of low back pain
About 90% low-back pain is non-specific, meaning the cause is unknown.
Doctors look for 'red flags' to identify specific problems like spinal diseases or tumours.
If the patient doesn't show any red flags, X-rays and other tests do not help to determine the cause of the pain.
Most people with back pain are able to continue working, or to return to work within a few days or weeks, even if they still have some residual or recurrent symptoms, and they do not need to wait to become completely pain free. But some people develop long-term pain or disability. It is usually hard to find visible physical damage when people experience back pain, and clinical tools like X-rays do not help doctors to judge which people will have long-term problems.
The longer the problem persists, the worse the outlook.
The severity of the condition is not the most important factor in predicting who will develop a long-term problem.
Psychological and social issues (life pressures and stresses) are important risk-factors for developing long-term disability.
Staying active despite the pain and returning to work as quickly as possible is the best approach to treatment.
Continuing ordinary activities despite the pain is much a more effective treatment than advice to rest or to 'let pain be your guide'. There is strong evidence that the active approach results in:
- Equivalent or faster relief from short-term symptoms
- Shorter periods of time off work
- Fewer reoccurrences of the pain
- Less time lost from work over the next year
- Education to help patients overcome fear and pain avoidance, and encouraging them to be responsible for their own care, may also be effective.
Patients should not wait until they are completely pain-free before returning to work.
When a person has experienced low back pain for 4-12 weeks they are at risk of a long-term disability. An intense effort should be made to help them return to work.
Workplaces may be able to help employees return to work more quickly by offering modified duties.
Multidisciplinary rehabilitation programmes (combining physical and psychological therapy) may be effective in treating low back pain.
A cooperative approach between employers, employees, health professionals and others is required to minimize the consequences of low back pain.
Physical demands at work can be associated with increased back symptoms and ‘injuries’, but they do not generally cause lasting physical damage. Overall, they are less important than other individual, non-occupational and unidentified factors. Disability due to low back depends more on psychological and social factors than physical work demands.
No. Medical opinion has changed dramatically in this area. When you experience an episode of back pain you should continue your normal activities, taking simple painkillers if necessary, and aim to remain at work if possible. A small amount of rest during the day is good for you but the more inactive you are the more prolonged the recovery period is likely to be.
Back pain is usually caused by nothing more than a sprain or strain of the muscles or ligaments of the back. Only around one per cent of people with back pain have something potentially serious causing their pain, but if you are concerned about anything - ask your GP.
'My doctor has told me I have arthritis in my spine, that means I’ve got serious disease in my spine and will end up in a wheelchair'
No. Arthritis is often described as 'wear and tear', spondylosis' or ‘osteoarthritis’ – the terms are usually used to describe the same thing. They describe the normal aging process of bony joints and discs. Just as hair goes grey and skin goes wrinkly, bones and joints age too - this is arthritis.
'My pain has gone on for months now - this must mean something is seriously wrong.'
Not necessarily. Back pain can take several weeks to completely go away. But if you are worried about how your back pain is progressing then make an appointment with your GP. You should certainly have seen your GP about your back pain if it has persisted for 6 weeks.
'My doctor has carried out tests, but the results were normal, does this mean that I am imagining my back pain?'
No. Your doctor may have carried out a series of tests to check for specific diseases. The results, if negative are usually good news as it means you don't have the condition that your doctor was testing for. This does not mean that your pain isn't real.
Your medical carers may well explore with you any psychological or social issues that could be contributing to your overall disability. Again, this doesn’t mean that your pain is imagined but perhaps your ability to cope with the pain is reduced because of these other factors.
'I can’t return to work until my pain has completely gone'
Maintaining normal activity promotes a quicker, and more complete, recovery. Continuing to go to work is part of your normal activity. You may still experience some pain whilst at work, but this tends to improve with time and won’t impede your recovery.
'I must have an X-Ray to find out what’s wrong with my back'
No. X-rays are not very good at picking up back problems other than arthritis, which most of us will get as we grow older. An X-ray is not likely to pick up the cause of over 90% of all back pain. And remember, X-rays are not entirely safe. You are exposed to potentially harmful radiation every time you have an X-ray. Your doctor will arrange an X-ray only when absolutely necessary.
An MRI scan will show a clear picture of the spine and its bones, joints, discs and nerves. However, an MRI scan is usually used only when there may be a need for surgery.
Health and Safety Executive - Information on manual handling legislation, risk assessments and good practice guidance.
Arthritis Research - Comprehensive booklet on back pain from a charity funding research into arthritic conditions.
In this section we cover the following areas:
- Working with Visual Display Screen (VDU) Equipment
- Occupational Asthma
- Occupational Dermatitis
- Vibration White Finger
- Work Related Upper Limb Disorder
- Occupational Hearing Loss
For reasons which are incompletely understood, the small arteries which supply the fingers and thumb become hypersensitive to vibration and develop a tendency to go into spasm when exposed to the cold. As a consequence, the affected finger blanches (turns white) along part, or all, of its length. More than one finger or thumb may be affected, in any combination.
Vibration White Finger is a component part of Hand Arm Vibration Syndrome which may also feature numbness of the fingers, tingling, clumsiness and reduced grip strength. The syndrome can cause significant disability and is reportable to the Health and Safety Executive.
The symptoms of Vibration White Finger, and Hand Arm Vibration Syndrome, may also be caused by other conditions. But because of the potential seriousness of Hand Arm Vibration Syndrome, a programme of Occupational Health surveillance exists throughout industry for employees who work with vibrating tools. The programme aims to help employees identify early symptoms, to give an accurate diagnosis of the underlying condition, to offer advice and to institute control measures to minimise the risk of long-term disability. Employees can also help by stopping smoking, wearing warm gloves, and by keeping their bodies as warm as possible.
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