Efforts by NIOSH to reduce the incidence of work related musculoskeletal injuries were discussed. The scope of the musculoskeletal injury problem was summarized. As a group, musculoskeletal injuries comprise the largest percentage of occupational injuries in the United States (US) and are ranked second in NIOSH's research priorities, surpassed only by occupational lung diseases. Musculoskeletal injuries to the trunk account for approximately 32 percent of all compensable injuries and 42 percent of worker compensation costs in the US. Labor intensive industries such as mining and construction have the highest rate of compensation claims for back injuries, averaging more than 1.5 claims per 100 workers annually. The proposed NIOSH national strategy for reducing the incidence of musculoskeletal injuries was discussed. It involves improving health and hazard surveillance systems, using multilevel databases at national, state, and local levels, evaluating causes and effects by coordinating scientific disciplines, controlling occupational risk factors by redesigning jobs and tools, training workers to use techniques that do not stress the musculoskeletal system, and selecting only individuals whose work capabilities meet or exceed the biomechanical demands of the job task, fostering an increasing awareness of musculoskeletal problems, and stimulating interventions. The authors conclude that the NIOSH strategy will help identify industries and occupations having a high risk for low back injury, evaluate potential task and personal risk factors, develop and validate comprehensive clinical evaluation systems and intervention strategies for musculoskeletal injuries, and provide technical assistance and technology transfer for musculoskeletal injury control.