The National Institute for Occupational Safety and Health NIOSH received a request from employees at a shoe manufacturing facility in West Virginia concerning exposure to ergonomic risk factors, including repetitive motion, and reports that employees in the trimming department were experiencing wrist, back, and shoulder pain. This plant produces men's welt sewn and cement glued shoes. Work related musculoskeletal disorders WRMDs have been found in previous studies to occur in workers whose jobs require repetitive movements, forceful exertions, and awkward body postures. WRMDs can affect the tendons, tendon sheaths, muscles, and nerves. Studies have shown that WRMDs can be precipitated or aggravated by activities that require repeated or stereotyped movements, forceful exertions, awkward postures, or exposure to hand arm vibration. Men's footwear, except at athletic SIC 3143 is listed among the Bureau of Labor Statistics industries with the highest nonfatal illness rates of disorders associated with repeated trauma, private industry, 1995. The 1995 incidence rate was 267.8 per 10,000 full-time workers.