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Managing musculoskeletal
By Prof Kim Burton
Sources of funding: spontaneously, so people should recover: workplace, and Black Flags to describe
The project was sponsored by: fortunately they generally do and the the context in which the person with
Faculty of Occupational medicine, experience is temporary. The trouble is the musculoskeletal problem functions -
Society for Back Pain research, that some people develop persistent pain including relevant people, systems and
BackCare, and have substantial difficulty getting on policies.4
Royal Mail, with their lives.
Transport for London, Flags are not a diagnosis, and should
HCML. When people fail to recover and return not be used to label people - using Flags
Publisher TSO hosts a dedicated website to activity and work in a timely way it is pejoratively defeats their whole purpose. mainly because psychosocial obstacles Identifying Flags complements the
impede progress, not because there is iagnosis: their relevance is as contributors
Conflicts of interest: None more serious injury or disease.1 Long- to the persistence of the problem.
term inactivity and time off work are
Job title: Occupational Health detrimental to health and well being, so A practical way to think of Flags is as
Consultant with Kendallburton helping people to stay active or working ‘obstacles’. Those that are modifiable should always be an imperative6. The can be overcome or got around. This
best way to tackle musculoskeletal perspective stresses ‘ability’
Address for correspondence: problems is to identify obstacles and rather than ‘disability’, and shifts
Prof Kim Burton develop a plan to deal with them, sooner the emphasis to actions that
30 Queen Street rather than later. Overcoming obstacles facilitate recovery and return
Huddersfield HD1 2SP needs action from the key players, to participation. In this sense, including the person themselves. obstacles can be transformed
into opportunities. People
In 1997, Kendall et al described an usually need help to overcome

A new evidence-based innovative approach to identifying and or navigate round obstacles. This
guide on musculoskeletal managing psychosocial factors in low is where Flags come in – they
problems has been back pain.3 They coined the term ‘Yellow point to the obstacles in need
published with sponsorship from Flags’ as an easily understood analogy of action. Problem-solving
BackCare. Intended for both the to the widely adopted ‘Red Flags’. approaches by
workplace and the clinic, it describes This development created something the key players
how to manage musculoskeletal of a sea change in the way common working
problems effectively by addressing musculoskeletal problems such as low together are
psychosocial obstacles taking back pain were conceptualised and often the most
account of biological and managed. Traditionally, the treatment useful fruitful.
biomechanical factors.2 of low back pain had been primarily
biomedical or biomechanical in emphasis,
We know that most people experience but longitudinal studies consistently
musculoskeletal problems some time demonstrated the importance of
during their lifetime, and this has psychosocial factors in the development
considerable impact on individuals and of persistent or chronic problems.5
their families. These problems are often Widespread adoption of the Yellow
a challenge to health professionals Flags approach subsequently occurred.
and are costly to industry, insurers and This innovative framework led to the
funders, the economy, and our societies. conceptual development of Blue
Most are either a minor injury or occur Flags to describe factors involving the
20 The Backcare Journal
backcare Winter 2009/10.indd 20 8/1/10 11:19:44
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