Identifying MSDs as the leading cause of sickness absence

Analysis of sickness absence data showed that musculoskeletal issues were the leading cause of days lost and represented a significant cost to the business. Investigations into these absences revealed that MSDs were not being handled consistently across Stadler Rail UK’s sites. Each location had its own practices, which led to large differences in how risks are managed and reported. This made it hard to understand what was causing MSDs and to take a coordinated, preventative approach.

From compliance to culture

Further investigation into risk management processes showed that cultural issues played a major role. They noticed several instances where employees were not working safely. A 'have-a-go hero' mentality meant some employees pushed beyond safe working practices; for example, not using the correct personal protective equipment (PPE), lifting loads that were too heavy, or doing two-person tasks on their own. All the evidence pointed to a culture where MSDs were more likely to occur. Unless the underlying beliefs were addressed, MSD rates would remain high.

To support this shift, Stadler Rail brought in an external consultancy specialising in cultural change. The programme was carefully structured, beginning with a senior leadership team to build a shared commitment to safety. The programme then moved through management and used a train-the-trainer model so that learning could be applied locally.

Stadler Rail uses a simple 'seatbelt analogy' to explain their aim. Rather than rely on a punitive approach, they wanted to shift the culture organically: '…back in the day when seatbelts were first introduced, it took quite a while for people to get comfortable with it. But nowadays people wear seatbelts because they want to for their own safety, and this is the sort of culture we want to permeate through the business', explains Kris Yorke, Head of Quality, Health, Safety and Environment (QHSE).

Introducing on-site physiotherapy support

Along with changing the culture, Stadler Rail set up an on-site physiotherapy service. The goal was to give employees early, practical intervention so that small aches and pains did not turn into serious long-term problems.

On–site physiotherapy, provided by Physiotherapy Matters, helps clinicians to look at both individual musculoskeletal issues and the work tasks that may be causing them. This approach allows them to take a full history, assess symptoms, observe tasks directly, and understand job design. From this, they can make a clinical judgement about whether work is part of the problem.

Stadler Rail’s advice for other organisations wishing to obtain an in-house physiotherapy service is to be clear on what you are trying to achieve from the start and make sure they find the right fit for your organisation. A wide range of providers are available in rail industry and organisations should assess their specific needs and select a provider best suited to their context.

From treatment to prevention

As the service became embedded, insights from individual cases showed wider organisational patterns. For example, work carried out in the pit was seen as an MSD risk. These trends helped Stadler Rail move from treating symptoms only to addressing root causes.

Where risks could not be removed, controls were put in place. For instance, the pit cannot be adjusted for employees of different heights, so physiotherapists focused on alternative strategies. These included job and task rotation, encouraging regular breaks, educating managers, and providing stretches and exercises for staff to use after working in the pit.

As clinicians were present on site, they were able to observe tasks directly and talk with employees. This allowed them to influence safe working practices in real time. When physiotherapists raised concerns, they worked together with Human Resources (HR), QHSE, and Operational Managers to develop solutions. These were then translated into updated policies, procedures, training materials, or work instructions.

The programme had a significant result. In 2025, Stadler Rail cut MSD-related sickness absence by 50.4%from their 2024 data —this is more than double their original target of 25%. Self reported presenteeism also fell by 20% from the start of treatment.

Staff feedback supported these results. Employees reported 100% satisfaction with the treatment received. Several long-term absence cases were resolved through tailored physiotherapy advice and by moving employees into suitable roles. This shows how early intervention and personalised support can make a real difference.

Despite these results, both organisations acknowledge that sickness absence rates are unlikely to continue falling at the same pace. It is important to recognise when an employee is unfit for work and may need time off. Unrealistically low sickness absence is not the goal; the priority is ensuring employees are supported to work safely.

Collaboration as the key to success

  • A strong partnership between departments is essential to success. When QHSE, HR and physiotherapists work together, they can spot repeating problems, update policies, improve risk assessments and strengthen reporting.
  • Lesley Roe, Head of People Transformation at Stadler Rail UK explains, 'When HR and QHSE come together with a shared purpose, we unlock solutions that are bigger than any one function. This collaboration between HR, QHSE, Physiotherapy Matters Ltd and managers, has allowed us to shift from reacting to problems to preventing them, building a culture where safe, healthy working is simply how we operate.'
  • Stadler Rail provided a recent example: several workers at one site reported similar MSD problems. The on-site physiotherapist noticed that their safety shoes might be causing the issue. This was shared with HR, QHSE and managers, who then started a full review of PPE across all sites. This collaborative approach helps the company spot wider organisational issues and address them consistently across the business.

Key challenges

  • Implementation was not without challenges. Operating across multiple sites required continued effort to align approaches and expectations. Early preparation and buy-in from sites were key. The service was introduced gradually through online drop in sessions. This helped employees and managers understand its purpose and view it as support rather than an added burden.
  • Shift patterns were also a challenge. It was essential for the service to be accessible for all employees, including those working night shifts. This required flexibility in appointment times; for example, appointments were extended and offered an hour before the start of the night shift.

Next steps: sustaining improvements in health, safety, and wellbeing

Stadler Rail has shifted towards a proactive approach to MSD management. Plans are underway to convert e-learning into bespoke, face-to-face, manual handling training. This will be tailored to specific roles and environments. Improvements in data collection and close-call reporting will help the organisation better manage risk. The long-term aim is to build a culture where safe behaviours happen automatically. This work forms part of Stadler Rail’s broader wellbeing strategy, including mental health. While the journey continues, Stadler Rail UK has laid strong foundations for ongoing improvement in employee health, safety, and wellbeing.