Lower limb disorders (a form of MSDs) – types and causes

Written by: Fit for Work team | Posted in: Blog

lower-limb-disordersLower limb disorders are musculoskeletal disorders (MSDs) that affect the hips, knees and legs. According to HSE, workers take an average of 25 days off work due to lower limb disorders (LLDs), and in 2009/10, around 2.4 million working days were lost due to LLDs.

There are two types of LLDs: those caused by acute injury and those caused by overuse. In the workplace, LLDs are most likely to be caused by overuse, but those who already have acute injuries – such as athletes and military personnel – may report these at work.

The most common risk factors for LLDs in the workplace are:

  • repetitive kneeling or squatting;
  • long periods of standing;
  • frequent jumping from a height.

LLDs that are most commonly work-related include the following:

Knee bursitis

Knee bursitis causes painful, swollen or tender knees and is caused by repetitive or extended periods of kneeling or activities that strain the knees. It is common in people who spend long periods of time kneeling, for example, carpet fitters, concrete finishers and roofers. It is also known as housemaid’s knee because housemaids historically spent long periods of time on their knees scrubbing floors.


Osteoarthritis is the most common type of arthritis in the UK and causes stiffness of the joints as their cartilage coating becomes damaged or worn. Osteoarthritis is most common in the back, knees and hips, and hip osteoarthritis is a particular risk for farmers. Knee osteoarthritis is a risk for miners, floor layers and cleaners. Those who are overweight are usually at increased risk.

Stress fracture

Stress fractures can occur as a result of micro-injuries to the bone. They are most prevalent in those who regularly march or stamp their feet, such as those in the military or long-distance runners. Stress fractures are more common in people who have osteoporosis (a disease where the bones become brittle).

Varicose veins

Varicose veins are swollen or enlarged veins that usually occur in the legs. These veins are usually blue or purple and can cause swollen feet ankles, muscle cramps and aching, heavy or uncomfortable legs – particularly after extended periods of standing. Those who are pregnant or overweight are at increased risk of developing varicose veins. Risk also increases in old age.

Meniscal lesions/tear damage

Meniscal lesions/damage usually occurs due to high rates of force being applied to the knee e.g. extended squatting, or heavy rotational force e.g. bending or twisting the knee whilst carrying a load. These type of lesions are often related to sports injuries and have also been linked to the development of osteoarthritis.

Advice for employees suffering from LLDs at work

If you think you may have an LLD, you should seek medical advice and report any symptoms to your employer as soon as possible. Your employer may be able to make adjustments to your workplace or job role and/or refer you to an occupational health professional.

You can also call the Fit for Work advice line on 0800 032 6235 (English) or 0800 032 6233 (Welsh).

If you have been off work for four weeks or more due to an LLD, ask your GP or employer for a referral to Fit for Work. See fitforwork.org for more information. To find out how Fit for Work helped an employee who was suffering from osteoarthritis return to work, see our case studies.

Those in Scotland can call 0800 019 2211 or visit fitforworkscotland.scot.

Advice for employers on management and prevention of LLDs

Effectively managing LLDs is not only beneficial for your employees’ health, it can also help to prevent sickness absence. Conversely, failing to manage the risk of LLDs in the workplace can result in higher levels of sickness absence as well as potential legal action against you.

As overuse is most likely to cause LLDs in the workplace, job roles and the workplace should be designed to reduce overuse as much as possible. You may consider:

  • providing mechanical aids for repetitive tasks;
  • rotating staff so that no one employee is doing a ‘risky’ activity for too long;
  • providing seating, where possible, to reduce long periods of standing for staff;
  • reducing the requirement for load-bearing where there is likely to be pressure on the joints;
  • consider the use of anti-fatigue matting where employees have to stand for long periods (ensuring this doesn’t result in a trip hazard);
  • making sure your employees take regular breaks.

A risk assessment can help you decide what action needs to be taken. Consulting your staff is also likely to be useful as they will potentially be able to provide suggestions about adjustments that might help them.

Personal protective equipment (PPE) such as kneepads may also be useful in preventing some LLDs, such as knee bursitis.

For advice on LLDs in the workplace and your responsibilities as an employer, call the Fit for Work advice line on 0800 032 6235 (English) or 0800 032 6233 (Welsh). Those in Scotland can call 0800 019 2211.

If you have an employee who has been off work for four weeks or more with an LLD, refer them to Fit for Work for a free occupational health assessment by visiting fitforwork.org/employer and clicking ‘refer an employee.’ To read about how Fit for Work helped an employee who was suffering from osteoarthritis return to work, see our case studies.

Those in Scotland can call 0800 019 2211 or visit fitforworkscotland.scot.

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