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Work-Related Musculoskeletal Disorders (WMSD) Prevention

Person rubbing wristsOnce assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseA generic term used in public health to describe a program or policy designed to have an impact on a health problem. for each intervention, details on designing interventions related to Work-related musculoskeletal disorders (WMSD), and links to examples and resources.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of WMSD prevention programs.

Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Work-related musculoskeletal disorders (WMSD) are conditions in which:

  1. The work environment and performance of work contribute significantly to the condition; and/or
  2. The condition is made worse or persists longer due to work conditions1

In 1997, the Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) released a review of evidence for work-related MSDs. Examples of work conditions that may lead to WMSD include routine lifting of heavy objects, daily exposure to whole body vibration, routine overhead work, work with the neck in chronic flexion position, or performing repetitive forceful tasks. This report identified positive evidence for relationships between work conditions and MSDs of the neck, shoulder, elbow, hand and wrist, and back.1

The Bureau of Labor Statistics of the Department of Labor defines MSDs as musculoskeletal system and connective tissue diseases and disorders when the event or exposure leading to the case is bodily reaction (e.g., bending, climbing, crawling, reaching, twisting), overexertion, or repetitive motion. MSDs do not include disorders caused by slips, trips, falls, or similar incidents. Examples of MSDs include:

  • Sprains, strains, and tears
  • Back pain
  • Carpal tunnel syndrome
  • Hernia2

Musculoskeletal disorders are associated with high costs to employers such as absenteeism, lost productivity, and increased health care, disability, and worker’s compensation costs. MSD cases are more severe than the average nonfatal injury or illness.

  • In 2001, MSDs involved a median of 8 days away from work compared with 6 days for all nonfatal injury and illness cases (e.g., hearing loss, occupational skin diseases such as dermatitis, eczema, or rash)2
    • Three age groups (25–34 year olds, 35–44 year olds, and 45–54 year olds) accounted for 79% of cases2
    • More male than female workers were affected, as were more white, non-Hispanic workers2
    • Operators, fabricators, and laborers; and persons in technical, sales, and administrative support occupations accounted for 58% of the MSD cases3
    • The manufacturing and services industry sectors together accounted for about half of all MSD cases2
  • Musculoskeletal disorders account for nearly 70 million physician office visits in the United States annually, and an estimated 130 million total health care encounters including outpatient, hospital, and emergency room visits3
  • In 1999, nearly 1 million people took time away from work to treat and recover from work-related musculoskeletal pain or impairment of function in the low back or upper extremities3
  • The Institute in Medicine estimates the economic burden of WMSDs as measured by compensation costs, lost wages, and lost productivity, are between $45 and $54 billion annually3
  • According to Liberty Mutual, the largest workers’ compensation insurance provider in the United States, overexertion injuries—lifting, pushing, pulling, holding, carrying or throwing an object—cost employers $13.4 billion every year3

Examples of common WMSDs are discussed below.

Carpal tunnel syndrome (CTS)

The U.S. Department of Labor defines CTS as a disorder associated with the peripheral nervous system, which includes nerves and ganglia located outside the spinal cord and brain. Carpal tunnel syndrome is the compression of the median nerve at the wrist, which may result in numbness, tingling, weakness, or muscle atrophy in the hand and fingers.4

  • Carpel tunnel syndrome may affect as many as 1.9 million people, and 300,000 to 500,000 surgeries are performed each year to correct this condition4
  • The Bureau of Labor Statistics reported 26,794 CTS cases involving days away from work in 2001, representing a median of 25 days away from work compared with 6 days for all nonfatal injury and illness cases. Most cases involved workers who were aged 25–54 (84%), female, and white, non-Hispanic (75%)4
  • Two occupational groups accounted for more than 70% of all CTS cases in 2001: operators, fabricators, and laborers; and technical, sales, and administrative support4
Back injury and back pain

Back symptoms are among the top ten reasons for medical visits. For 5% to 10% of patients, the back pain becomes chronic.6

  • In 2001, the Bureau of Labor Statistics reported 372,683 back injury cases involving days away from work. Most cases involved workers who were aged 25–54 (79%), male (64%), and white, non-Hispanic (70%)7
  • Two occupational groups accounted for more than 54% of back injury cases: operators, fabricators, and laborers (38%); and precision production, craft, and repair (17%)7

Data from scientific studies of primary and secondary interventions indicate that low back pain can be reduced by:

  • Engineering controls (e.g., ergonomic workplace redesign)
  • Administrative controls (specifically, adjusting work schedules and workloads)
  • Programs designed to modify individual factors, such as employee exercise
  • Combinations of these approaches
Arthritis

The term arthritisA term used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue.  is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Forty-six million Americans report that a doctor told them they have arthritis or other rheumatic conditions. Arthritis is the most common cause of disability in the United States.8 Arthritis limits the activities of nearly 19 million adults.9 Two thirds of individuals with arthritis are under age 65.10

The National Arthritis Data Working Group estimates that 27 million adults have osteoarthritis. Nine million adults report symptomatic knee osteoarthritis, and 13 million report symptomatic hand osteoarthritis. Persons are considered to have symptomatic osteoarthritis if they have frequent pain in a joint (e.g., pain in a joint on most days of a recent month) and radiographic (e.g., x-ray) evidence of osteoarthritis in that joint, although sometimes this pain may not actually emanate from the arthritis seen on the radiograph. Other forms of arthritis include rheumatoid arthritis and gout. Arthritis is a concern in the workplace both because it may develop from work-related conditions and because it may require worksite adaptations for employees with limitations or disabilities.11-12

Certain occupations are associated with increased prevalence of arthritis, specifically osteoarthritis, most often of the knee and/or hip. These occupations include mining, construction, agriculture, and sectors of the service industry.12-13 Common features of these occupations are physically demanding/heavy labor tasks, lifting or carrying heavy loads, exposure to vibration, high risk of joint or tissue injury, and prolonged periods of working in awkward or unnatural postures such as kneeling and crawling.

  • In 2003, the total cost for arthritis conditions was $128 billion—$81 billion in direct costs and $47 billion in indirect costs14
  • Persons who are limited in their work by arthritis are said to have Arthritis-attributable work limitations (AAWL). AAWL affects one in 20 working-age adults (aged 18-64) in the United States and one in three working-age adults with self-reported, doctor-diagnosed arthritis15
  • The National Business Group on Health recommends that employers address arthritis by encouraging workers to avoid obesity and providing ergonomically appropriate workplace design16

Early diagnosis and appropriate management of arthritis can help people with arthritis decrease pain, improve function, stay productive, and lower health care costs. Appropriate management includes consulting with a doctor and self management education programs to help teach people with arthritis techniques to manage arthritis on a day-to-day basis.  Physical activity and weight management programs are also important self-management activities for persons with arthritis.

Developing and Implementing Workplace Controls

Engineering controls, administrative controls and use of personal protective

A three-tier hierarchy of controls is widely accepted as an intervention strategy for reducing, eliminating, or controlling workplace hazards, including ergonomic hazards. The three tiers are:

  • Use of engineering controls
    • The preferred approach to prevent and control WMSDs is to design the job to take account of the capabilities and limitations of the workforce using engineering controls. Some examples include:
      • Changing the way materials, parts, and products can be transported. For example, using mechanical assist devices to relieve heavy load lifting and carrying tasks or using handles or slotted hand holes in packages requiring manual handling
      • Changing workstation layout, which might include using height-adjustable workbenches or locating tools and materials within short reaching distances
  • Use of administrative controls (changes in work practices and management policies)
    • Administrative control strategies are policies and practices that reduce WMSD risk but they do not eliminate workplace hazards.  Although engineering controls are preferred, administrative controls can be helpful as temporary measures until engineering controls can be implemented or when engineering controls are not technically feasible. Some examples include:
      • Reducing shift length or limiting the amount of overtime
      • Changes in job rules and procedures such as scheduling more breaks to allow for rest and recovery
      • Rotating workers through jobs that are physically tiring
      • Training in the recognition of risk factors for WMSDs and instructions in work practices and techniques that can ease the task demands or burden (e.g., stress and strain)
  • Use of personal protective equipment (PPE)
    • PPE generally provides a barrier between the worker and hazard source. Respirators, ear plugs, safety goggles, chemical aprons, safety shoes, and hard hats are all examples of PPE
    • Whether braces, wrist splints, back belts, and similar devices can be regarded as offering personal protection against ergonomic hazards remains an open question. Although these devices may, in some situations, reduce the duration, frequency or intensity of exposure, evidence of their effectiveness in injury reduction is inconclusive. In some instances, these devices may decrease one exposure but increase another because the worker has to “fight” the device to perform the work. An example is the use of wrist splints while engaging in work that requires wrist bending
Ergonomics

ErgonomicsThe science of designing the job and the workplace to suit the capabilities of the workers. Simply stated, ergonomics means "fitting the task to the worker." The aim of ergonomics is the evaluation and design of facilities, workstations, jobs, training methods, and equipment to match the capabilities of users and workers, and thereby reduce stress and eliminate injuries and disorders associated with the overuse of muscles, bad posture, and repeated tasks. is the science of fitting workplace conditions and job demands to the capability of the working population.1 The goal of ergonomics is to reduce stress and eliminate injuries and disorders associated with the overuse of muscles, bad posture, and repeated tasks. A workplace ergonomics program can aim to prevent or control injuries and illnesses by eliminating or reducing worker exposure to WMSD risk factors using engineering and administrative controls. PPE is also used in some instances but it is the least effective workplace control to address ergonomic hazards. Risk factors include awkward postures, repetition, material handling, force, mechanical compression, vibration, temperature extremes, glare, inadequate lighting, and duration of exposure.17 For example, employees who spend many hours at a workstation may develop ergonomic-related problems resulting in musculoskeletal disorders (MSDs).

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Health-related programs to prevent WMSDs6, 18-26

Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.

Provide lifestyle health promotion programs in the workplace
  • Studies have shown that exercise (i.e., improving overall fitness, strength, and flexibility) can reduce the incidence of low back pain, but the results are moderate and temporary
  • Weight management can lower a person’s risk for osteoarthritis and the pain and disability that accompany arthritis can be decreased through early diagnosis and appropriate management, including self-management activities such as weight management and physical activity
  • Research has shown that physical activity decreases pain, improves function, and delays disability for persons with arthritis
  • The health-related program strategies and interventions for physical activity and obesity include lifestyle activities that can be promoted to individuals with arthritis and low back pain
Provide training to management and workers regarding workplace risks for WMSDs
  • Instructional training programs aimed at reducing workplace injuries are frequently promoted as a readily available and an economical approach to the control of workplace injury
  • The CDC National Institute for Occupational Safety and Health (NIOSH) recommends training to expand management and worker ability to recognize, evaluate and reduce potential WMSDs risks
  • Training programs can include a focus on general ergonomics awareness (e.g., lifting and lowering, pushing and pulling, carrying, risk factors such as posture and vibration); formal instruction in job analysis for identifying and controlling risk factors for WMSDs; and how to develop a team approach to build consensus and problem solve ergonomics issues in the workplace
  • Training is not intended to have workers or managers diagnose and treat WMSDs, but raise awareness and knowledge of the type of health problems that may be work-related and when to refer employees for medical evaluation
  • The CDC National Institute for Occupational Safety and Health (NIOSH) Elements of Ergonomic Programs primer contains detailed discussion and examples on developing training programs
Community education programs on arthritis self-management are effective in managing arthritis
  • Self-management education is a key step in improving health outcomes and quality of life for people with arthritis. It focuses on self-care behaviors, such as being physically active, managing pain, goal-setting, communicating with providers, and other skills. It is a collaborative process in which trained instructors help people with arthritis gain the knowledge, problem-solving and coping skills, and the belief in their own capabilities (i.e., self-efficacy) needed to successfully self-manage the disease and its related conditions

Tools and Resources (more)


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Health-related policies to prevent WMSDs18-26

Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”

Design policies to demonstrate management commitment to worker safety
  • The CDC National Institute for Occupational Safety and Health (NIOSH) has developed a primer, Elements of Ergonomic Programs, outlining the basics of implementing and evaluating workplace ergonomic programs which includes recommendations for workplace management to reduce WMSDs; a toolkit of techniques and methods; and illustrations of the practical experiences gained by NIOSH through workplace investigations. The primer focuses on the following seven steps for addressing WMSD concerns in a workplace which can demonstrate the employer’s commitment to worker safety
    • Look for signs of potential WMSD problems in the workplace such as job tasks that require repetitive, forceful exertion
    • Show management commitment in addressing possible problems by encouraging worker involvement in problem-solving activities
    • Offer training to management and workers to enhance knowledge and skill in evaluating potential WMSDs
    • Gather data to identify jobs or work conditions that are the most problematic
    • Identify effective controls, such as engineering controls related to workstation layout, for tasks that pose WMSD risks
    • Establish health care management emphasizing the importance of early detection and treatment of WMSDs
    • Minimize risk factors when planning new work processes and operations
Policies that enhance worksite lifestyle programs such as physical activity are important in managing arthritis
  • Research has shown that physical activity decreases pain, improves function, and delays disability for persons with arthritis
  • Research suggests that maintaining a healthy weight reduces the risk of developing arthritis and may decrease disease progression
  • The health-related policy strategies and interventions listed for nutrition and physical activity include lifestyle activities recommended that can be promoted to individuals with arthritis
Disability management and return to work policies can provide support to employees with WMSDs
  • Policies and programs that are designed to prevent, treat, and/or rehabilitate WMSDs (disability management) or facilitate the return of ill, injured or disabled employees to work as soon as they are able to perform meaningful, productive work in accordance with a physician’s guidance (return to work) are beneficial to both the employer and employee. There are several reasons for employers to implement effective disability management and return to work programs beyond the human and financial costs to the employer and employee including:
    • Contributing to a safer work environment
    • Maintaining a skilled workforce in the event of employee disability
    • Assisting employees with re-entry to the workforce following an injury or illness through transitional work and reasonable accommodations
    • Increasing workers sense of security knowing that their employer will provide support and assistance in the event of disability

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Health benefits to prevent WMSDs18-24

Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.

Encourage prevention of impairment and disability from WMSDs through health care management strategies and policies
  • Employers, employees, and health care professionals working together can enhance a workplace ergonomics program by creating an environment that encourages early detection, treatment, and timely recovery from work-related musculoskeletal disorders (WMSD)
    • Employers can provide education and training to employees on signs and symptoms of WMSDS and encourage early reporting and prompt evaluation by health care providers
    • Employers can also give health care providers the opportunity to become familiar with jobs and job tasks associated with the workplace
    • Employees should follow proper workplace safety and health rules and procedures
    • Health care providers should be experienced and trained in evaluating and treating WMSDs and ensure employee privacy and confidentiality to the fullest extent permitted by law
Provide education to employees regarding worker compensation and disability benefits
  • Employers can educate employees regarding worker compensation and disability benefits, including available protections and accommodations covered by the Americans with Disabilities Act
Health benefits that support physical activity are important in managing arthritis
  • Research has shown that physical activity decreases pain, improves function, and delays disability for persons with arthritis
  • The health benefits strategies and interventions listed for physical activity (e.g., subsidizing gym memberships) can be promoted to individuals with arthritis

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Environmental support to prevent WMSDs18-26

Environmental support provides a worksite physically designed to encourage good health.

Intervention strategies for controlling ergonomic hazards that are associated with risk factors for WMSDs include developing engineering and administrative controls
  • The preferred approach to preventing and controlling WMSDs revolve around the design of jobs and job tasks. Job design related to ergonomic interventions includes workstation layout; selection and use of tools; and work methods that account for the capabilities and limitations of workers such as modifying or accommodating employees with functional limitations secondary to WMSDs
  • If risk factors for WMSDs are present following a job analysis, employers can implement engineering controls to reduce ergonomic risk including: changing workstation layout such as locating tools within short reaching distances; changing the way materials or parts are transported or manipulated such as using mechanical assist devices; changing work processes or products to reduce exposures to risk factors
  • Administrative controls can also be helpful in the short term until more permanent engineering controls are established, if possible
  • Common administrative controls for reducing the risk of WMSDs include: reducing shift length or limiting overtime; scheduling more breaks to allow rest and recovery; rotating workers through several jobs with different physical demands to reduce stress on the body; and adjusting the pace of work to relieve repetitive motion risks and increase worker control of the work process
  • The CDC National Institute for Occupational Safety and Health (NIOSH) Elements of Ergonomic Programs primer contains detailed discussion and examples on developing, implementing, and evaluating engineering and administrative controls

Environmental support for physical activity or weight management is effective in improving health outcomes for persons with arthritis

  • Research has shown that physical activity decreases pain, improves function, and delays disability for persons with arthritis
  • Research suggests that maintaining a healthy weight reduces the risk of developing arthritis and may decrease disease progression
  • The health-related environmental support strategies and inverventions for physical activity and nutrition include lifestyle activities that can be promoted to individuals with arthritis

Tools and Resources

  • Leading by Example: Creating Healthy Communities through Corporate Engagement published in 2011 by the Partnership for Prevention features 19 businesses and business groups who are providing leadership and reaching out to improve the health and wellness of their communities providing many benefits to their organizations.
  • Leading by Example: The Value of Worksite Health Promotion to Small- and Medium-sized Employers published in 2011 by the Partnership for Prevention provides best practices and strategies for creating or enhancing worksite health promotion program as well as worksite health program descriptions from almost 20 small employers
  • The Job Accommodation Network, supported by the U.S. Department of Labor’s Office of Disability Employment Policy, publishes Job Accommodations for People with Arthritis, a fact sheet with examples of workplace accommodations for people with arthritis
  • The Association of Occupational and Environmental Clinics (AOEC) and the Society of Occupational and Environmental Health (SOEH) with support and contributions from the CDC National Institute for Occupational Safety and Health (NIOSH), The Center for Construction Research and Training (CPWR), the U.S. Veteran’s Administration (VA), AARP, the Occupational Safety and Health Administration (OSHA), the American Public Health Association (APHA), and the Work and Health Research Center (WHRC) at the University of Maryland School of Nursing hosted a conference in 2009 titled, “Healthy Aging for a Sustainable Workforce [PDF - 1.2MB].” The conference report generated several recommendations for programs and policies to address workplace injuries and illnesses such as work-related musculoskeletal disorders which can be found on pages 17-19 and on pages 35-37 with respect to older construction workers in the report

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