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Global Standing at work is bad for a pregnancy
Britain Reps stand up for the right to sit down
Australia Deadly grounds for a sit down protest
Britain Stamping out foot problems
South Korea Union campaign to seat workers
Australia Caring hurts nurses’ feet
USA US employers make bad stand on chairs
Denmark Too much standing can land you in hospital
Artwork Ned Jolliffe
Download a PDF of the Hazards article Standing Problem
Millions of UK workers spend most of the working day on their feet. Hazards editor Rory O’Neill warns there are serious health reasons why they shouldn’t stand for it.
In the 1870s and 1880s, 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 in unsuitable shoes (1).
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 (2).
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” (3). Even then it wasn’t news. Bernardino Ramazzini, the “father of occupational medicine,” called in 1700 for a reduction is the amount of work requiring constant standing (4).
Today, the “cruelty” continues. 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, circulatory problems, including a possible increased stroke risk, birth defects and difficulties in pregnancy. It could even affect your mental health.
At risk jobs include:
Tell Hazards if your job is missing from the list.
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 (5). 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.
Although this is a major health and safety and comfort issue for millions of UK workers, there has never been a Health and Safety Executive prosecution for a breach of the current 12-year-old health and safety regulation covering provision of seating at work.
HSE’s prosecution and notices database contain no records of prosecutions under section 11 paragraph 3 of the Workplace (Health Safety and Welfare) Regulations 1992, the law requiring provision of suitable seats where the work or a substantial part of it can be done sitting. The database reveals HSE has issued just five improvement notices relating to this law.
The database also show no seating related prosecutions under the VDU regulations, and just one improvement notice under these regulations relating to provision of an unsuitable chair.
Standing is not an inevitable part of working life. Dr Finn Tüchsen, of Denmark’s National Institute of Occupational Health (AMI), told Hazards: “The proportion of workers standing at least 75 per cent of their working day is 30-40 per cent in Scandinavia and 50-70 per cent in north America.”
He pointed out that in Sweden, however – a country with a stellar record on occupational health – a study found only 19 per cent of men and 15 per cent of women aged 20-64 worked standing more than one-tenth of their day (7).
These discrepancies suggest that whether or not a worker is required to stand or not seems to have little relation to productivity considerations.
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, told Hazards: “A really common reason for workers to stand is ‘image’. In the West - but not in Asia, Africa, South America and parts of Europe - standing is thought to convey availability and courtesy; sitting in the presence of customers may be thought rude.
“This can be carried to extremes such that workers are forbidden to sit even if there are no customers in the store. This is where unions become important because both management and customers have to be brought to realise that sales and service personnel whose feet, legs and backs hurt are not going to be giving as friendly, smiling service as those who are feeling comfortable.”
Messing concluded: “To my mind, this is a social class problem. No one accuses physicians or lawyers of being rude because they receive their clients while sitting.”
A Hazards survey this year of UK union health and safety officers found widespread problems from standing at work. Unions representing shopworkers, warehouse staff, teachers, library staff, production line workers, museum workers, bank workers, school supervisors, train drivers, printers, engineers, cleaners and hospitality and casino workers all reported difficulties experienced by some of their members.
Doug Russell, national safety officer with retail union Usdaw, says his union has “a history of having to fight to maintain the idea that seating should be allowed at checkouts in retail.”
The better employers, including Tesco and Sainsbury’s, accept “the best practice is to provide a seat and to give the operator the choice to vary between sitting and standing over the course of their shift,” Russell said. But others, including major high street firms, do not.
The union is currently in dispute with Boots retail, whose new checkouts, already in use in some stores and set for a national roll-out, are designed for standing use only. “The goods handled by Boots staff are clearly things that can be handled safely while seated so we believe regulation 11 should apply,” he said.
“I think personally the law - regulation 11 of the Workplace Regulations - is perfectly clear and straightforward. However we have come across several occasions where employers have tried to remove seats and make sales jobs and checkout work standing only - apparently because it somehow makes for better customer service!”
After the 7 July 2005 London bombings, a major London museum removed the stools used by gallery minders, saying they should be standing or walking round the galleries being more vigilant for “odd” people and activities. The plan was withdrawn within days thanks to union pressure and the efforts of the local PCS safety rep, who presented evidence of the health risks associated with constant standing.
The problem is one that is commonplace in the leisure industries. TGWU regional organiser Nick Grainger told Hazards: “British casino operators have been notorious in their opposition to access to chairs for croupiers, while imposing long, unsocial hours standing at gaming machines.”
Standing most of the working day every working 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 pack.
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 (8). 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,” UQAM’s Professor Messing told Hazards.
Her studies suggest back pain associated with work is about twice as common in those who stand compared to those who usually work sitting, even after controlling for age and lifting weights. “Pain is never trivial since it is the body's way of telling us that something is wrong and that we should take action,” she said.
According to Messing, prolonged standing that is not under the worker's control seems to be the most uncomfortable. “By ‘control’ I mean if the worker can decide to sit whenever they find it necessary… we would expect that static, constrained prolonged standing would be worst from the point of view of circulation. Too much walking, however, appears to make the feet hurt more.”
A 2002 review of 17 studies of the health risks associated with prolonged standing (9) concluded these included chronic venous insufficiency, musculoskeletal pain of the lower back and feet, preterm birth and spontaneous abortions.
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. Other workers – for example, those with varicose veins caused by pregnancy, with arthritis or who have suffered a back or lower limb injury – may also find themselves in difficulties.
Strong evidence linking prolonged standing at work to an increased risk of heart problems and stroke has recently come to light. Researchers have linked prolonged standing to an increased risk of carotid atherosclerosis, which in turn can cause an increased risk of heart attack and stroke (10).
And a paper presented to a major international conference on work and cardiovascular diseases in March 2005 indicated “prolonged time in an upright posture at work constitutes a risk factor for the development of hypertension comparable to 20 years of aging, which in turn is one of the accepted major risk factors for the development of cardiovascular disease” (11).
Another paper reported evidence that “upright posture at work constitutes a major risk factor of the development of atherosclerosis, comparable to the risk found for traditional risk factors such as smoking, high blood pressure, and high cholesterol.” (12).
• painful feet and legs
Professor Messing’s studies have found that workers are far more likely to be required to stand if they are in lower status jobs. These workers also find it difficult to raise issues of their comfort for “fear that clients and supervisors would think they were lazy”.
She said: “Unfortunately, prolonged standing may have a lasting effect on their physical health, and the lack of respect associated with standing may affect their psychological health.”
In a major international report on “new” epidemics in occupational health published in 2005 (7), in a chapter on the hazards of prolonged, constrained standing, Professor Messing wrote: “The idea that workers may be made to do degrading, demeaning or painful work simply because it is not dangerous is outrageous, yet the current climate… clearly allows usual working conditions to inflict pain and even degradation.”
The potentially serious health problems causes by prolonged standing are not taken seriously by occupational health and safety authorities, believes Messing, because the researchers looking at workplace health issues just don’t get it – they have “decision latitude” so could stand all day, but could equally well sit, shuffle or sidle off whenever the urge overtook them.
“At the Swedish National Institute for Working Life, researchers are so convinced of the positive effects of standing that some have arranged their computer workstations so as to type standing, although they do not spend all day in a constrained standing position,” Messing said.
“One of the researchers was only persuaded to become interested in constrained static standing by a reminder of sensations he had experienced in museums. We have now dubbed this kind of occupational exposure ‘museum walking’ in order to interest researchers whose own occupational exposures may not have included prolonged static standing” (7).
Researchers at the US Mayo Clinic predicted in 2005 that office workstations could be redesigned so workers spend their working day not at a desk, but on an exercise treadmill. A team at the clinic are already working at their own prototype computer treadmills (15).
Researchers can check out when they want. Retail staff behind checkouts only get to escape when the shift ends.
The health effects associated with prolonged standing will vary with the job – whether for example, you are stood 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 (5). 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. The resultant discomfort and leg oedema often dictate change or modification of the job.”
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, or in some transport jobs, for example train drivers.
Train drivers’ union ASLEF told Hazards that train drivers do suffer from knee problems, although it has proved difficult to identify the precise cause. Dave Bennett, national safety officer with ASLEF, said: “Some drivers prefer to stand, at least for part of the driving turn. We try to ensure cabs and seats are designed to be as adjustable as possible, including the option of being able to stand.”
The safe solution
Constant sitting is not the safe alternative to constant standing, infact 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.
Professor Peter Buckle of the Robens Centre for Health Ergonomics at the University of Surrey and colleagues have recommended workers spend no more than 30 per cent of their working day standing (16). Similarly, the Canadian autoworkers’ union CAW (17) advises its members that “working on your feet for more than 30 per cent of the work shift can produce health effects, so we must raise these issues in our health and safety committee meetings and at the bargaining table.”
CAW adds: “We need to negotiate suitable chairs with backs for workers and more rest periods for those who must stand or walk.”
CAW says key objectives of union negotiations should be to:
According to Professor Messing: “In factory jobs, the new, fashionable modular production sometimes forces workers to stand because they are rotating constantly from job to job. In those cases it would be good to discuss alternatives with the workers. They usually like changing jobs but might want to change less often so they could sit. Revamping the work area might also help.”
For workers who are used to doing a job in a particular way at a particular workstation – behind a checkout, the counter at a bank or at a machine – standing may seem like an uncomfortable but inevitable part of the job.
Professor Messing told Hazards: “When we ask workers why they are standing, some explain why the job makes it impossible to sit. For example, in one bank, tellers had to step back to open a money drawer in front of them once every 20 seconds, making it impossible to sit, even though seats were available. This could have easily been corrected by moving the drawer or by putting the money somewhere more easily accessible.”
As evidence that improvements are possible in almost any job, she points to the work of the joint union-management safety organisation, ASSTSAS, which successful designed a seat to allow dental hygienists to sit while working (18).
She added: “There is no magic answer that works for all jobs.” While studies suggest for some jobs the best solution is to have a comfortable chair the worker can use some or most of the time, for others “a good compromise is a sit/stand chair that is quickly and easily adjustable so that the workers can sit, stand or lean on it as they like, depending on what they are doing at the time.
“Psychologically, sit/stand chairs also help avoid the situation where a standing customer is towering over a seated service worker.”
Talking to unions and union reps could make the whole process of finding safe, productive solutions a lot less painful, Usdaw national safety officer Doug Russell told Hazards. He cites the example of Makro, the cash and carry warehouse chain, when it introduced new checkouts. These were basically avenues through which trade customers wheeled flat-bed trolleys heavily laden with bulk buys and where staff scanned items with hand-held scanners.
“Not only was there no seat, there were no belts or counters,” said Russell, adding that, at least theoretically, there was no need to handle the goods either. “In practice not all shoppers at Makro are wholesale customers. There are a large number who use the conventional supermarket trolleys and the operator had to lift boxes out of one trolley into another to scan them.”
When management realised it was possible for shoppers to hide items between the large boxes, they wanted staff to handle heavy items to make sure no contraband was hidden.
“There were various design problems with the new checkouts and there had been no consultation with us,” Russell said. “Several local authorities threatened the company with enforcement action. They spent a lot more money on a report by another ergonomic consultant who recommended major changes including replacing all their supermarket trolleys with a new shallower design.
“They did eventually come and talk to us. Five years later the net result is that in most of their stores 50 per cent of checkouts are now the conventional seated design – for supermarket trolley shoppers – and 50 per cent are the new design.”
If you must stand for it…
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 flooring, anti-fatigue mats and personal protective equipment (PPE).
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 (19).
Thick foam-rubber mats should be avoided. Too much cushioning can cause fatigue and increase the risk of tripping.
The acid test of any measures is user opinion – if the workers say it doesn’t work, then other solutions must be found.
General health and safety duties
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. That should mean avoiding prolonged standing where alternative means of doing the job are possible, particularly if these methods are used successfully by other employers.
Regulation 11 (paragraph 3) of the Workplace (Health Safety and Welfare) Regulations 1992 says: “A suitable seat shall be provided for each person at work in the workplace whose work includes operations of kind that the work (or a substantial part of it) can or must be done sitting.” The law says the seat must be suitable for the person using it. It should have a footrest where necessary.
The HSE guide for managers on these regulations says: “If work can or must be done sitting, seats which are suitable for the people using them and for the work done there should be provided. Seating should give adequate support for the lower back, and footrests should be provided for workers who cannot place their feet flat on the floor.”
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).
The Provision and Use of Work Equipment Regulations 1992 say work equipment must be suitable for its intended use (regulation 5).
The Health and Safety (Display Screen) Regulations 1992 also require provision of suitable, adjustable seating.
Both the Disability Discrimination Act and the Sex Discrimination Act can apply in occupational health and safety settings, where employers fail to take adequate measures to accommodate workers.
The Construction (Health, Safety and Welfare) Regulations require provision of rest facilities (regulation 22).
The Health and Safety Executive’s 'A guide for new and expectant mothers who work' (20) sets out a two step approach to protecting pregnant workers.
Stage one – the initial risk assessment. Employers should identify and eliminate any hazards and risks to women employees. This is a wide-ranging obligation, and includes new and expectant mothers, and potential risks to the unborn child, or to the child of a woman who is still breastfeeding. The risk assessment requirement should take account of all women of "childbearing age”, not just those already pregnant of who have given birth.
Stage two - undertake a risk assessment specific to any worker who has informed the employer they are pregnant, or who have given birth in the last six months or who are breastfeeding, based on the initial assessment or any medical advice the worker has provided from their GP or midwife.
The guide adds: “The Management of Health and Safety at Work Regulations 1999 (MHSW) include regulations that protect the health and safety of new and expectant mothers who work. Under the Sex Discrimination Act 1975, if an employer fails to protect the health and safety of their pregnant workers, it is automatically considered sex discrimination.”
HSE’s 'New and expectant mothers at work: A guide for employers' (21) provides more detail on the risks and what employers must do to avoid them. It says the kind of precautions an employer should consider taking depend on the kind of work, but could include letting a worker sit down if their job involves standing and making sure they have regular short breaks.
And HSE’s information sheet for new and expectant mothers in the catering industry (22) says: “Fatigue from prolonged standing or workload involving much physical effort can lead to problems with the development of the baby. Ensure they can take short breaks. Ensure seating is available where possible.”
The Occupational Health Centre for Ontario Workers (5) recommends pregnant workers should not be required to stand for more than two hours in a row, and even then floor matting should be provided.
SAFETY REPS’ CHECKLIST
1. Ames A Jr. Sex in industry: A plea for the working girl. Osgood, Boston, 1875.
2. Linder M and Salzman CL. A history of medical scientists and high heels, International Journal of Health Services, vol.28, no.2, pages 201-225, 1998.
3. Cruelty to women. Lancet, page 729, 8 May 1880.
4. Franco G and Fusetti L. Bernardino Ramazzini’s early observations of the link between musculoskeletal disorders and ergonomic factors, Applied Ergonomics, vol.35, no.1, pages 67-70, January 2004.
5. Working on your feet. Occupational Health Clinics for Ontario Workers. www.ohcow.on.ca
6. Health of the munition worker, Health of Munition Workers Committee, Minister of Munitions, HMSO, 1917.
7. Messing K and others. Pain associated with prolonged constrained standing: The invisible epidemic. In: Occupational health and safety: International influences and the “new” epidemics, Eds. Chris L Peterson and Claire Mayhew, Baywood, 2005. ISBN 0-89503-303-8. more
8. Self-reported work-related illness in 2003/04: Results from the Labour Force Survey. HSE, 2005. [pdf]
9. McCulloch J. Health risks associated with prolonged standing. Work, vol.19, no.2, pages 201-5, 2002.
10. Krause N and others. Standing at work and progression of carotid atherosclerosis, Scandinavian Journal of Work, Environment and Health, vol.26, no.3, pages 227-36, 2000.
11. Lisa Dasinger, Krause N, Brand R, Kaplan GA , Salonen JT. Percent time at work in an upright posture associated with 11 year change in systolic blood pressure. Paper presented to the 4th International Conference on Work Environment and Cardiovascular Diseases under the auspices the International Congress of Occupational Health (ICOH), Newport Beach, California, USA, March 9-11 2005.
12. Niklas Krause, Dasinger LK, Brand R, Kaplan GA , Salonen JT: Standing, walking and climbing stairs at work associated with 11 year progression of artherosclerosis. Paper presented to the 4th International Conference on Work Environment and Cardiovascular Diseases under the auspices the International Congress of Occupational Health (ICOH), Newport Beach, California, USA, March 9-11 2005.
13. Tüchsen F, Krause N and others. Standing at work and varicose veins, Scandinavian Journal of Work, Environment and Health, vol.2 no.5, pages 414-20, 2000.
14. Lin S, Gensburg L and others. Effects of maternal work activity during pregnancy of infant malformations, Journal of Occupational and Environmental Medicine, vol.49, no.9, pages 829-834, 1998.
15. Mayo Clinic creates "Office of the future", news release, 25 May 2005.
16. Buckle P and others. Musculoskeletal disorders (and discomfort) and associated factors. In: Corlett N, Wilson J and Mananica J (eds), Proceedings of the International Conference on Working Postures, Zadar, Yugoslavia. Taylor and Francis, 1986.
17. Working on your feet, factsheet,
18. Guide de prévention des troubles musculo-squelettiques en clinique dentaire, ASSTSAS, 2002. more
19. Prolonged standing: Taking the load off. Workers’ Health and Safety Centre, Canada, 2002. more
20. A guide for new and expectant mothers who work, HSE. [pdf]
21. New and expectant mothers at work: A guide for employers HSG122, (Second edition), HSE Books, 2002. ISBN 0 7176 2583 4.
22. Health and safety of new and expectant mothers in the catering industry, HSE Information sheet number 19. [pdf]
23. Have a seat UAW Solidarity magazine, January-February 2005.
Society of Chiropodists and Podiatrists more
Workplace health safety and welfare: A short guide for managers. HSE. [pdf]
Workplace (Health Safety and Welfare) Regulations. London Hazards Centre factsheet
Standing at work factsheet, AMWU, Australia [pdf]
Teen worker safety in restaurants, OSHA eTool, USA. more
ILO Encyclopaedia of Occupational Health and Safety guide to occupationally related leg, ankle and foot problems. more
Workplace (Health, Safety and Welfare) Regulations 1992, advice for local authority enforcement officers. Health and Safety Executive/Local Authorities Enforcement Liaison Committee (HELA). more
Global: Standing at work is bad for a pregnancy
Britain: Reps stand up for the right to sit down
Australia: Deadly grounds for a sit down protest
out foot problems
Union campaign to seat workers
Caring hurts nurses’ feet
US employers make bad stand on chairs
Too much standing can land you in hospital
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