Work SMARTey
Pain comes with working in the early years. It doesn’t have to.
98% of the early years staff we surveyed reported experiencing pain whilst working. Work SMARTey is a research-based programme to change that.
- On this page
- Where we began
- What we did
- What we found
- Why pain persists
- If you run a setting
- What comes next
- Your role
Welcome
- Read about Work SMARTey below, or go straight to the page for your role:
- Owners and decision makers
- Managers and leaders
- Practitioners
- Media and resources
Work SMARTey is a research programme on pain among early years staff: how common it is, why it so often goes unaddressed, and what can be done about it. It is run by Research Well, working with the University of Derby, the Early Years Alliance, the National Education Union and Jolly Back.
This page tells the story so far: why we started, what we did, what we found, why the pain persists, what it means for the people who run settings, and what comes next. Read it from top to bottom, or use the buttons above to jump to any part.
Looking for something specific? See the pages for your role to find out how Work SMARTey can help, or read the research for the full findings and methods.
In plain words
What is musculoskeletal pain?
Your musculoskeletal system is your body’s framework and the parts that let you move: bones, muscles, joints, tendons and ligaments. It is what lets you stand, kneel, lift and carry.
When something goes wrong in this system, such as a strain, a sprain or wear and tear, it is called a musculoskeletal disorder (MSD). The most common sign is pain, known as musculoskeletal pain. The back, neck, shoulders and knees are common places.
When people routinely experience this pain whilst they are at work, it is called work-related musculoskeletal pain. We sometimes shorten this to MSP. It is what Work SMARTey is about. Other terms are explained in the glossary.
Where we began
Ask anyone who has worked in early years. They will tell you about the kneeling, stooping and crouching, and the lifting and carrying of children and equipment. Many will also tell you about the pain that comes with it, their own or a colleague’s.
Those accounts reached us through professional networks and personal relationships, before Work SMARTey existed. When we looked at what was already known, we found two things. Studies of early childhood staff in other countries had found high levels of work-related pain. And we could find no research that had looked at it in UK early years at all.
The stories from UK practitioners suggested the same problem was here too. But without research, no one could say how widespread it was, how much harm it was doing, or what kind of action would help. Those are the questions Work SMARTey set out to answer.
“It feels like it’s more or less an expected part of the job, judging by the way other staff members describe their pain.”
Practitioner
What we did
We could find no UK research that had asked early years staff about their pain, so we asked them ourselves. The work has run in stages, each building on the last.
Stage 1 · Published 2024
A national survey
196 practitioners and leaders from across the UK
The first national study of its kind in the UK: where people hurt, how often, what their working days involve, and which tasks go with more frequent pain.
Stage 2 · In peer review
In their own words
239 written comments, from 174 of the 196 people who took part
What it is like to live and work with pain, why so many keep quiet about it, and what happens when they speak up.
Stage 3 · In preparation
Testing what helps
A pilot in early years settings, testing practical support built on what we have learned, so that we can see what works.
The questions we asked. How would your team answer?
- Where does it hurt?
- How often, and for how long?
- What does a working day involve?
- Has pain kept you off work?
- Have you told anyone at work, and what happened?
- Has it made you think about leaving?
How the study worked, in more detail
Practitioners and leaders from across the UK took part. As well as how common pain is, the survey measured how severe it is, how long it lasts, when it began and how much it bothers people. This let us compare people in leadership or management roles with those working mainly with children, and use regression analysis to find what predicts a greater likelihood of pain. Stage 2 is a qualitative analysis of the written comments. See the research page for the full account.
What we found
Almost everyone is in pain, and it builds.
Four things stood out, and the staff who answered us put it better than we can.
A grid of 100 dots, 98 of them filled in.
98 in every 100 early years staff we surveyed reported experiencing pain whilst working. For 89 in every 100, it was in the lower back.
Finding 1
It’s almost universal.
Nearly everyone reported pain whilst working, and for most it had started more than a year before. The lower back was the most common place.
“I have to take strong painkillers daily in order to fulfil my role.”
Practitioner
Finding 2
It builds over a career.
The longer people had worked in early years, the more parts of their body hurt, and age alone did not explain this.
“I’m only 26, what is my body going to be like in the next 10 years?”
Practitioner
Finding 3
The tasks matter.
The more often people lifted, stooped or worked at floor level, the more often they were in pain and the more likely they were to need time off.
“Sitting on little chairs and lifting children… can cause pain that makes me cry.”
Leader
Finding 4
People stay quiet.
Many described pain as something that comes with the job. They held back because they thought nothing could be done, or because they did not want to be a bother.
“Don’t want to be a bother.”
Practitioner
“Nothing left to give to my family by the time I get home.”
Practitioner
Why pain persists
Four reasons the pain goes unaddressed.
Pain in early years is not a mystery, and it is not down to individuals. Our findings point to four clear reasons, each building on the last.
The work is physically demanding, and support is limited.
Early years roles involve a lot of lifting, stooping, kneeling and working at floor level, often in rooms and with furniture made for children rather than adults. The more often people did these tasks, the more often they were in pain. Yet the equipment and help to reduce them is often limited.
- “Have to pack away and set up equipment each week… The constant getting down to children’s levels (2, 3, 4 year olds) affects knees.”Leader
- “Struggle with constant bending and getting up and down off the floor and small chairs.”Leader
- “Chairs were bought but difficult as not enough of them and little children move around all the time.”Practitioner
Pain is dismissed, normalised or played down.
When pain comes, it is often treated as part of the job, put down to age or posture, or seen as not worth mentioning, especially when there has been no specific injury. So many people never report it.
- “I just accepted it as part of my job.”Leader
- “I assumed it was my incorrect posture or not sitting down instead of leaning or bending over.”Practitioner
- “Because I haven’t actually had an accident that caused the pain.”Practitioner
A lack of action from organisations when pain is reported.
Just over half of the people we surveyed (52%) had told a manager about their pain. Yet for many, nothing happened: the report was noted, a promised change never came, or a review never took place. Many practitioners summed up what happened next in a single word: “Nothing.”
- “Just noted.”Practitioner
- “Told to just take it easy.”Practitioner
- “I was measured for a chair but never got one.”Practitioner
- “Had an initial risk assessment and told not to do nappies or tidy up for 2 weeks, then would review… 5 weeks later still no review and back to normal duties.”Practitioner
Actions taken vary, and often treat the symptoms rather than the source.
Actions which are taken when pain is reported vary considerably, often offering only limited support, aimed at reducing the symptoms rather than the source of the problem. Some staff were referred to occupational health, given a chair or excused from some tasks for a while. Advice on lifting is common, yet reviews of the evidence find that lifting training on its own does not prevent back pain (Verbeek et al., 2011; Oakman et al., 2024). And support usually comes only after pain has been reported, rather than helping to prevent it, and is often too narrow for what is a complex problem, about more than the physical demands of the job.
- “Allowed a large chair for period of treatment.”Practitioner
- “We were given advice on how to lift things…”Practitioner
- “Refreshed manual handling course and attended chiropractor sessions.”Leader
If you run a setting
Pain is pushing good people out.
Over a third of the staff we surveyed (36%) had thought about leaving their job because of pain. Most were not losing interest in the work. They were worried about what it was doing to their bodies.
“Just preparing my team for me to leave in next 3–5 years as I don’t feel I will be able to do my job role any more as I struggle now.”
Leader
“Figured a life with less pain was worth a pay cut.”
Practitioner
“Constant pain affects mental health, passion for the job and my professional effectiveness.”
Leader
Leaders are in pain too, and often have no one to tell. Of the leaders who had not reported their pain, 33 said it was because they were the manager or owner, or because there was no one to report to.
“I am the manager and feel that my committee would not be responsive to my medical needs.”
Leader
Low absence does not mean low cost: many staff keep working through pain, which is much harder to see. Much of this can be changed, and the people who run settings, and the owners, committees and organisations they answer to, are best placed to change it.
What comes next
Next: turning the evidence into practical support.
We are now turning what we have learned into practical support for settings, and testing it in a pilot. Register your interest to be among the first to hear about it.
Your role
Work SMARTey for your role.
Owners and decision makers
I own, fund or make decisions for one or more settings
- See what pain may be costing your organisation
- Find out how Work SMARTey can help
- Get answers to the questions owners ask
- Talk to us about the pilot
Managers and leaders
I run or manage a setting
- See how pain shows up in a setting
- Find out why low absence does not mean everything is fine
- See why approaches so far have not solved it
- Register interest in the pilot
Practitioners
I work with children
- See what practitioners told us
- Find out why so many people stay quiet
- Find out how to raise it at work
- Get answers to the questions practitioners ask
Sector body, funder or potential partner? Get in touch.
Stay in touch
Join the Work SMARTey mailing list.
Hear first about the pilot, new tools and free resources for your setting.
Want to get in touch directly? Email us at WorkSMARTey@ResearchWell.co.uk.
In the media
Work SMARTey in the media.
- Nursery World, 2024. Long read: chronic back pain part of the job for most early years workers.
- Occupational Health Today, 2026. A two-part series for iOH, the Association of Occupational Health and Wellbeing Professionals.
- Nursery Management Today, 2024. “We have your back.”
Project partners
Work SMARTey is a collaboration between:
- Research Well
- University of Derby
- Early Years Alliance
- National Education Union
- Jolly Back