Executive summary: What HR leaders need to know
Key points:
Back pain and mental health have a hidden link, with employees calling in sick with physical symptoms when there is actually an underlying mental health cause
UK businesses spend £71 billion annually in combined MSK and mental health-related absence
25% of UK workers report feeling unable to cope with workplace stress, yet only 38% of line managers are equipped for mental health conversations
Addressing both physical and psychological wellbeing together delivers £5 return on investment for every £1 spent
Practical solutions exist to identify and support employees experiencing this dual challenge
When your apprentice accountant calls in sick citing back pain again, do you ever wonder what's really going on?
As an HR professional, you've likely noticed the pattern: recurring musculoskeletal (MSK) absences that don't quite add up, employees who seem reluctant to discuss their symptoms, and a growing disconnect between reported physical ailments and the underlying workplace pressures you're witnessing.
What appears to be a straightforward physical complaint could mask deeper mental health challenges that employees feel unable or unwilling to discuss, or even recognise in themselves. Back pain and mental health is costing UK businesses billions. According to Arthritis Research UK, back pain alone costs the UK economy £20 billion every year, whilst Deloitte research shows that poor mental health costs UK employers £51 billion annually, leaving countless employees without the support they truly need.
The current situation: 2024/2025 workplace mental health data
The numbers show a clear picture of workplace wellbeing in the UK.
According to MHFA England's latest 2024 research, 25% of UK workers report feeling unable to cope with workplace stress, whilst 79% of employees are experiencing moderate-to-high stress levels, with younger employees and women showing the highest stress levels.
According to the Mental Health Foundation, poor mental wellbeing costs employers in the UK an estimated £42 billion to £45 billion annually through presenteeism, sickness absence and staff turnover . More recent research by Deloitte reveals this figure has risen to £51 billion per year as of 2024.
Meanwhile, the Health & Safety Executive's latest statistics show that work-related musculoskeletal disorders affected 477,000 workers in Great Britain in 2021/22, leading to 7.3 million lost working days. These disorders comprised 27% of all work-related ill-health cases.
So what's the issue?
According to research by NAMI (National Alliance on Mental Illness), while most Americans believe it's appropriate to talk about mental health at work, many are not prepared or feel comfortable to do so. Although this data comes from the US, there is much that the UK can learn from these findings about workplace mental health stigma and communication barriers. UK data from Spill confirms this trend, showing only 38% of HR respondents say their line managers are equipped for sensitive conversations around mental health. This could create a situation where genuine psychological distress manifests as physical symptoms that feel more acceptable to report.
The financial impact cannot be ignored. When we add the hidden costs of misreported conditions to the documented figures, the true economic burden becomes even more substantial.
Understanding why a mental health problem may be masked by workplace back pain complaints may be down to one of three things:
the psychological phenomenon of somatisation, where mental distress can present as physical symptoms,
the persistent stigma that may prevent employees from openly discussing their mental health challenges,
or simply the employee themselves may not realise that their physical pain has roots in workplace stress.
1. When back pain masks mental distress (somatisation)
Something we all need to remember: the body and mind are connected. Chronic stress, anxiety, and depression don't just affect how we feel emotionally – they can create real, measurable physical symptoms. Back pain might be the body's way of expressing psychological distress.
The medical evidence is clear: according to research published by the Mayo Clinic, when we're stressed or anxious, our muscles tense, with the back, shoulders, and neck being particularly vulnerable to this tension. Over time, chronic stress can lead to genuine musculoskeletal problems. The key point is that treating the physical symptoms without addressing any underlying mental health issues may not provide lasting relief.
This leads to what researchers call "somatisation" – when psychological distress shows up as physical symptoms. According to the NHS-affiliated patient resource Patient.info, somatisation occurs "...when physical symptoms are caused by mental (psychological) or emotional factors" .
Employees aren't being dishonest or trying to deceive you. They may genuinely experience back pain, but the root cause could lie in their mental and emotional wellbeing rather than purely physical factors.
2. Why employees report physical rather than mental symptoms (stigma)
For many employees, saying "I have back pain" feels safer than admitting "I'm struggling with my mental health."
There's still significant stigma around mental health conditions, despite our best efforts to create inclusive workplaces. Back pain, by contrast, feels legitimate, understandable, and doesn't invite uncomfortable questions about personal resilience or professional capability.
Recent research highlights this challenge. According to Champion Health's 2024 data, whilst 60% of employees experience anxiety symptoms, only 10% are currently seeking support for their mental health. This massive gap between need and help-seeking behaviour often manifests in alternative ways of expressing distress – including through physical complaints.
3. When employees don't recognise the connection (lack of awareness)
Perhaps most significantly, many employees experiencing stress-related back pain simply don't realise there's a connection between their mental state and their physical symptoms. This lack of awareness is completely understandable. The pain feels entirely real and physical, and most people aren't trained to recognise the mind-body connection.
Research shows that chronic stress and anxiety can create genuine physical changes in the body, including muscle tension, inflammation, and altered pain perception. When someone is under prolonged workplace stress, their body may remain in a constant state of tension, leading to very real musculoskeletal pain. To the individual experiencing it, this feels like a purely physical problem requiring physical treatment.
This awareness gap means that employees may repeatedly seek treatment for back pain without ever addressing the underlying stress, anxiety, or depression that could be driving their symptoms. They're not hiding their mental health struggles – they genuinely don't recognise that their physical pain might have psychological roots.
When someone is under prolonged workplace stress, their body may remain in a constant state of tension, leading to very real musculoskeletal pain.
Workplace factors that make the problem worse.
Your workplace environment plays a key role in this relationship between physical and mental health. Recent HSE statistics reveal that stress, depression, or anxiety accounted for 49% of all work-related ill health and 54% of working days lost due to such health issues. This coincides with changing work patterns, increased pressures, and ongoing uncertainty in many industries.
Several workplace factors contribute to both back pain and mental health challenges:
Sedentary work and remote working issues: According to HSE guidance on workplace health, long hours at desks create physical strain whilst also contributing to feelings of disconnection and mental fatigue. The pandemic has made this worse, with US research showing that 41.2% of home workers experienced low back pain, with neck pain affecting 23.5%. Remote working has created new problems, with many employees working from poor home setups using kitchen chairs and badly positioned monitors.
Work-related stress: HSE statistics reveal that 875,000 workers experienced stress, depression or anxiety due to work-related factors in 2022/23. Research shows that tight deadlines, heavy workloads, and job insecurity create chronic stress that shows up physically. The back often bears the brunt of this tension, with stress-related muscle tension contributing to genuine physical pain.
Lack of control: When employees feel powerless over their work environment or responsibilities, stress levels rise. According to HSE research on workplace stress, this psychological pressure often translates into physical symptoms. A 2024 study found that 70% of managers cite organisational barriers to supporting staff wellbeing, including company policy and unsupportive workplace culture.
Poor workplace relationships and isolation: According to workplace wellbeing research documented by HSE, conflict with colleagues or managers creates ongoing stress that the body absorbs and expresses through tension and pain. Remote working has made this worse, with many employees reporting increased feelings of isolation and reduced team connectivity.
Inadequate support systems: Without proper mental health support, employees may unconsciously channel their distress into physical complaints that feel more manageable to address. HSE data indicates that over 16 million working days were lost due to stress, depression, or anxiety in 2023/24. Yet research shows that only 38% of HR professionals believe their line managers are equipped to have sensitive conversations around mental health.
How this affects your absence management
This relationship between back pain and mental health creates a challenge for workplace health reporting. You may be seeing inflated MSK absence figures whilst mental health issues remain underreported. This makes it difficult to allocate resources effectively and address the real health challenges your workforce faces.
When employees consistently report back pain for what might be stress-related issues – whether due to somatisation, lack of awareness, or stigma – several problems can emerge:
Wrong occupational health referrals: Your occupational health assessments may focus on physical treatments that don't address any underlying cause. This could lead to frustrated employees, repeated absences, and wasted healthcare resources. The British Pain Society reports that chronic pain costs the UK billions, with back pain alone accounting for 40% of sickness absence in the NHS.
Ineffective workplace health programmes: Your wellness programmes might focus on ergonomic improvements and physical treatments whilst potentially neglecting the mental health support that could be more effective. Research by the University of Chicago shows that for every $1 invested in targeted mental health actions brings a return of $4 in benefits through decreased absenteeism and improved productivity.
Inconsistent absence management: Your policies may not account for the psychological factors that could influence physical symptoms, potentially leading to inconsistent decision-making and potential discrimination issues.
Ongoing employee distress: The employees themselves might remain stuck in a cycle where their real needs aren't being met, potentially leading to ongoing distress and longer-term health complications.
The business case for taking action
Understanding and addressing the link between back pain and mental health is about being a caring employer and smart business. Research by the Mental Health Foundation finds that, on average, there is a positive return on investment of around £5 for every £1 invested in mental health. Additional research by the University of Chicago shows returns of $4 for every $1 invested in targeted mental health interventions.
When you address the whole person rather than just the reported symptoms, research suggests you could see:
Reduced absence duration: Studies show that employees whose underlying mental health needs are met typically recover more quickly from both physical and psychological symptoms. According to ComPsych research, when employee mental health is invested in up front, absenteeism is reduced, as well as presenteeism, or lost productivity when a person isn't able to perform at optimal levels. Additionally, Deloitte Insights set out the benefits of mental health support in reducing absenteeism, showing that investments in mental health programs in the workplace generate returns of five times their original value.
Lower recurrence rates: Research indicates that treating root causes rather than symptoms leads to more sustainable recovery and fewer repeat absences. According to a study published in BMC Public Health, it is possible to influence the recurrence rate of sickness absence due to adjustment disorders, with intervention groups showing 20% lower risk of recurrent sickness absence. This is particularly important given that mental health-related conditions often become chronic without proper intervention.
Improved engagement and productivity: Studies consistently find that employees who feel genuinely supported and understood are more likely to be engaged, productive, and loyal. According to the World Health Organization, workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains. Additionally, research shows that 86% of employees treated for depression report improved work performance.
Better resource allocation: Research shows that knowing the true nature of health challenges allows you to invest in the most effective support systems, avoiding the costly cycle of repeated failed interventions. ComPsych data demonstrates that integrated behavioural health programmes, including preventative care to support those struggling with mental health challenges, lead to reduced absenteeism and better resource use.
Enhanced reputation and recruitment: Studies show that organisations known for their comprehensive approach to employee wellbeing attract better talent and enjoy improved employee retention in an increasingly competitive job market. According to EVERFI research, employee wellbeing is key in attracting, recruiting and retaining top talent.
Creating psychologically safe environments for authentic reporting
The key to breaking this cycle lies in creating an environment where employees feel safe to be honest about their mental health challenges.
There are practical steps you can take.
Invest in manager training: Equip line managers with the skills to have sensitive conversations about both physical and mental health. They need to understand the connection and know how to respond supportively when an employee hints at deeper issues. Current data shows that only 38% of HR respondents believe their managers are equipped for these conversations.
Make mental health discussions normal: Regularly communicate about mental health in the same way you would discuss physical safety. Make it clear that psychological wellbeing is equally important and valued. WHO guidelines emphasise that creating mentally healthy workplaces has long-reaching benefits for employers, employees and society as a whole.
Provide multiple reporting channels: Some employees may never feel comfortable discussing mental health face-to-face. Offer anonymous reporting systems, self-referral options, and online resources. Recent data shows that 47% of employees are more interested in using digital tools to support their mental health than before the pandemic.
Ensure confidentiality and trust: Be clear about how mental health information is handled and protected. Trust is essential for honest reporting, and breaches can set back progress significantly.
Lead by example: When senior leaders speak openly about their own wellbeing challenges or the importance of mental health, it gives others permission to do the same.
A complete approach to occupational health
The most effective workplace health strategies recognise that physical and mental wellbeing are connected. When an employee reports back pain, consider it an opportunity to explore their overall wellbeing rather than simply arranging a physiotherapy referral.
A comprehensive approach might include:
Integrated health assessments: Train your occupational health professionals to consider all three factors – somatisation, stigma, and awareness gaps – in every assessment. Back pain should trigger questions about stress, sleep, workplace relationships, and overall life satisfaction, whilst also exploring the employee's understanding of potential connections between their mental and physical wellbeing.
Flexible treatment options: Offer support that addresses both physical symptoms and underlying mental health concerns. This might include stress management programmes, counselling services, workplace adjustments, and traditional physical treatments.
Remote work considerations: With remote working remaining common post-pandemic, address the specific challenges this creates. Research shows that home workers face increased risks of both MSK disorders and mental health issues due to ergonomic challenges and isolation.
Workplace wellness programmes: Design initiatives that support both physical and mental health. Yoga and mindfulness programmes, for example, can address back pain whilst also providing stress relief and mental health benefits.
Return-to-work planning: Develop return-to-work plans that consider the whole person. If stress or anxiety contributed to the absence, ensure these factors are addressed before the employee returns.
Regular monitoring and check-ins: Put in place systems that explore both physical comfort and mental wellbeing to identify issues before they become serious problems.
Working with expert healthcare providers
This is where working with a healthcare provider who understands workplace wellbeing becomes valuable. At Verve Healthcare, proactive workplace healthcare can reduce sickness absence by identifying and addressing health issues before they escalate into long-term problems.
With 30 years' NHS experience, Verve Healthcare understands both the clinical and workplace aspects of health and can help you navigate these connections. Verve Healthcare's core expertise is in healthcare and we also work with other professionals who can help your teams to recognise when back pain might indicate broader wellbeing concerns and provide the appropriate support pathways.
The goal is to create a workplace culture where employees feel safe to discuss their real challenges and receive appropriate, comprehensive support.
At Verve Healthcare, proactive workplace healthcare can reduce sickness absence by identifying and addressing health issues before they escalate into long-term problems.
Action plan for HR leaders
As an HR professional, you can drive positive change in how your organisation approaches the connection between physical and mental health. Here's your action plan:
Immediate actions (Week 1-2):
Check your current data: Review absence patterns looking for recurring MSK complaints. Are certain employees repeatedly absent for back pain? Do absences happen during stressful periods or workplace changes?
Assess manager capability: Survey your line managers about their confidence in handling both MSK and mental health conversations. The current benchmark shows only 38% feel equipped.
Review policies: Ensure your absence management and occupational health policies acknowledge the connection between physical and mental health.
Short-term initiatives (Month 1-3):
Put in place manager training: Provide mental health awareness training that includes understanding physical manifestations of psychological distress.
Create safe reporting channels: Establish multiple ways for employees to discuss health concerns, including anonymous options.
Partner with expert providers: Work with healthcare providers like Verve Healthcare who understand integrated wellbeing approaches.
Medium-term strategy (Month 3-6):
Develop integrated support programmes: Create wellness initiatives that address both physical and mental health simultaneously.
Establish measurement systems: Track both mental health and MSK-related absences to understand the true picture of workplace wellbeing.
Build psychological safety: Put in place culture change initiatives that make mental health discussions normal.
Long-term transformation (6+ months):
Embed holistic thinking: Make integrated physical and mental health consideration standard practice across all HR processes.
Measure and refine: Continuously assess the effectiveness of your approach and adjust based on outcomes.
Share success stories: Use positive examples to encourage further culture change and demonstrate ROI. physical manifestations of psychological distress.
Create safe reporting channels: Establish multiple ways for employees to discuss health concerns, including anonymous options.
Partner with expert providers: Work with healthcare providers like Verve Healthcare who understand integrated wellbeing approaches.
Different sectors, different challenges
Different sectors face unique challenges in addressing the back pain and mental health connection:
Healthcare workers: Face high stress levels and physical demands. According to the British Pain Society, back pain alone accounts for 40% of sickness absence in the NHS (https://www.britishpainsociety.org/mediacentre/news/british-pain-society-press-release-chronic-pain-costs-the-uk-billions-but-research-funding-is-inadequate/), often stress-related.
Office workers and remote employees: Struggle with ergonomic challenges and isolation. Research published in the International Journal of Environmental Research and Public Health shows 41.2% of home workers experience back pain, often linked to stress and poor setups (https://pmc.ncbi.nlm.nih.gov/articles/PMC7503869/).
Manufacturing and manual labour: Face both physical and psychological pressures, with MSK disorders affecting their ability to work and contributing to mental health challenges.
Education sector: Experiences high stress levels with physical symptoms often masking burnout and anxiety.
Different age groups, different approaches
Different age groups approach mental health and physical symptoms differently:
Younger employees (16-34): More likely to openly discuss mental health but may still use physical symptoms as a 'safer' route to absence. MHFA England data shows this group has the highest stress levels.
Mid-career professionals (35-54): Often face the highest pressure to appear resilient, making them most likely to disguise mental health issues as physical complaints.
Older employees (55+): May come from generations where mental health stigma was stronger, but are often more willing to discuss physical ailments.
Common questions for HR professionals
Q: How can HR tell the difference between genuine back pain and stress-related symptoms?
A: The key is not to distinguish but to address all possibilities. Genuine back pain can be caused by stress, stress can worsen existing back problems, and employees may not realise the connection. Focus on comprehensive assessment rather than trying to categorise symptoms.
Q: What legal obligations do employers have for mental health vs physical health?
A: Under the Health and Safety at Work Act, employers have equal duties to protect both physical and mental health. The HSE provides guidance on managing workplace stress as a health and safety issue.
Q: How much should companies budget for holistic workplace health?
A: Research shows that investing £80 per employee in wellbeing initiatives results in approximately £600 in savings. The Mental Health Foundation reports £5 return for every £1 invested in mental health support.
Q: What if employees resist mental health support?
A: Start with general wellbeing initiatives that address both physical and mental health without requiring disclosure. Yoga, mindfulness, and stress management programmes can help both issues simultaneously.
Q: How do we handle employees who clearly have mental health issues but only report physical symptoms?
A: Focus on creating a supportive environment where they feel safe to be honest. Provide multiple support options and ensure managers are trained to have sensitive conversations that explore underlying issues.
Q: What are the warning signs that back pain reports might mask mental health issues?
A: Look for patterns: recurring absences during stressful periods, reluctance to discuss symptoms in detail, lack of improvement with standard treatments, absence coinciding with workplace changes, and importantly, employees who seem surprised when you suggest stress might be a contributing factor – indicating a potential awareness gap.
Quick assessment: Is your workplace contributing to hidden mental health issues?
Rate your organisation (1-5 scale, where 5 is excellent):
□ Line managers feel confident discussing both physical and mental health (Current UK average: 2/5)
□ Employees feel safe reporting mental health concerns without stigma
□ Your occupational health assessments consider both physical and psychological factors
□ Absence patterns are analysed for both MSK and mental health trends
□ Workplace stress management is proactive rather than reactive
□ Remote working setups support both physical comfort and mental wellbeing
□ Return-to-work processes address underlying causes, not just symptoms
Scoring:
30-35: Excellent integrated approach
20-29: Good foundation, room for improvement
15-19: Significant gaps to address
Below 15: Urgent action needed
The investment vs the cost of doing nothing
The cost of doing nothing:
Average MSK absence: 7.3 million working days lost annually
Average mental health absence: 16.4 million working days lost annually
Combined cost to UK economy: Over £71 billion annually
Hidden costs of misdiagnosis and repeated failed treatments
Legal risks from inadequate support
The investment in change:
Manager training: Address wider issues within businesses earlier, helping address non-healthcare issues like processes, managerial capability, team effectiveness and work-environment factors before they cause health problems for staff members.
Integrated health assessments: Verve Healthcare has a solution for occupational health assessments that consider both physical and mental health factors , with costs varying depending on scope and requirements.
Comprehensive wellbeing programmes: According to MHFA England research, organisation-wide early interventions provide the highest return for employers, at £6.30 for every £1 spent. Verve Healthcare offers integrated programmes including access to GPs, mental health support, and physiotherapy services through Verve On Demand.
Expert healthcare partnership: Verve Healthcare's proactive workplace healthcare solutions are tailored to organisation size and needs.
Expected returns:
Up to £5 return for every £1 invested (Mental Health Foundation)
$4 return for every $1 invested in targeted mental health interventions (University of Chicago)
Reduced absence rates by 25-40%
Improved productivity and engagement
Enhanced recruitment and retention
Building a healthy, happy and productive workforce
The connection between back pain and mental health represents both a challenge and an opportunity for forward-thinking employers. When you acknowledge this link and respond with comprehensive, compassionate support, you create a workplace where employees feel valued, supported, and able to bring their whole selves to work.
Workplace wellbeing is not just the right thing to do, it also makes good business sense. When you invest in understanding and addressing the real health challenges your employees face – whether they present as back pain, stress, or anything in between – you're investing in a more resilient, engaged, and productive workforce.
The employees who currently feel they must disguise their mental health struggles as physical complaints deserve better. They deserve workplaces where authenticity is valued, where support is comprehensive, and where their wellbeing is genuinely prioritised.
Your next steps
Understanding the hidden connection between back pain and mental health is just the beginning. The real transformation happens when you act on this knowledge to create meaningful change in your workplace.
Week 1: Complete the assessment tool above and check your current absence data
Week 2: Survey your managers about their confidence levels and training needs
Month 1: Put in place initial training programmes and policy reviews
Month 2: Establish partnerships with expert healthcare providers
Month 3: Launch integrated wellbeing initiatives
Month 6: Measure progress and refine approaches
Year 1: Embed holistic thinking across all HR practices
Consider partnering with healthcare providers who can offer the expertise and support your organisation needs to address these complex wellbeing challenges. Look for providers who understand both the clinical aspects of health and the unique pressures of the modern workplace.
Remember, every employee who feels safe enough to be honest about their mental health challenges is an employee who can receive the right support at the right time. This honesty leads to better outcomes, reduced absences, and stronger workplace relationships.
The path to a truly healthy workplace starts with recognising that physical and mental health are connected. When you treat them as such, you're not just reducing absence costs or improving productivity metrics – you're creating an environment where people can thrive.
Your employees' wellbeing is in your hands. By acknowledging the relationship between back pain and mental health, you're taking an important step towards building the healthy, happy and productive workforce that every organisation deserves.
Take action today
The evidence is clear, the business case is strong, and the solutions are within reach. Don't let another day pass where employees suffer in silence, disguising their mental health struggles as physical complaints.
Start your transformation journey today by:
Assessing your current situation
Training your managers to recognise the signs
Creating safe spaces for honest conversations
Partnering with experts who understand integrated wellbeing
Enabling access to healthcare support for those who need it
Measuring progress and celebrating success
The future of workplace wellbeing depends on leaders like you taking action. Your employees are counting on you to create a workplace where they can be authentic about their challenges and receive the comprehensive support they need.
Ready to transform your approach to workplace wellbeing? Discover how Verve Healthcare's proactive workplace healthcare can help you address the real health challenges your employees face. With three decades of NHS experience, we understand the connections between physical and mental health in the workplace. Our integrated approach helps organisations create healthier, more productive workforces whilst delivering measurable returns on investment. Contact Verve Healthcare today to learn how we can support your journey towards a truly holistic approach to employee wellbeing.
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