Musculoskeletal Health Program

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Burden, Need and Impact

NIOSH strives to maximize its impact to protect the workforce. The NIOSH Musculoskeletal Health Cross-Sector Program identifies priorities to guide investments, and bases those priorities on the evidence of burden, need and impact. Below are the priority areas for the NIOSH Musculoskeletal Health Program:


The cost of MSDs is a serious concern to the NIOSH Musculoskeletal Health Program. According to the 2014 National Safety Council data, work-related sprains, strains, and tears are twice as likely to result in workers’ compensation claims as fractures, cuts, lacerations, amputations, bruises, contusions, burns, and chemical burns combined.1 Workplace overexertion injuries are estimated to cost $15.1 billion a year and account for about 25% of the total workers’ compensation cost.2 According to the Bureau of Labor Statistics, full-time workers are estimated to miss a median of 11 days of work due to sprains, strains, and tears, a median of 33 days due to tendonitis, and a median of 30 days due to carpal tunnel syndrome.3


Workers’ compensation covers more than one hundred million U.S. workers. Unfortunately,  workers’ compensation data is limited by how many workers report their pain to management, how many managers submit complete and accurate records, and how records are processed.4 Men are less likely to report work stress than women; minority racial and ethnic groups are less likely to report work stress than non-Hispanic whites; and workers with more demanding schedules (nurses, for example) are less likely to report work stress than workers with standard schedules. Current research also suggests that work-related injuries and illnesses are underreported because organizations do not comply with OSHA recordkeeping regulations. It is even difficult to discern what kind of compensation data has been reported because there is no standardized definition of a “musculoskeletal disorder”.5


Work-related illness and injury data can be accessed through private industry, state, local government and federal government workers’ compensation systems.Using these systems, the NIOSH Musculoskeletal Health Program and the NIOSH Center for Workers’ Compensation Studies (CWCS) are collaborating on identifying industries with high risk for MSDs and determine trends of musculoskeletal injuries and illnesses within industries,6 and recommend tailored intervention strategies. With expert guidance from the Musculoskeletal Health Program, NIOSH has published the following industry-specific ergonomic intervention guidelines:

1NSC (National Safety Council) [2015]. National Safety Council Injury Facts: 2015 Edition. Itasca, IL: National Safety Council, icon

2Liberty Mutual [2017]. Liberty Mutual workplace safety index 2017. Hopkinton, MA: Liberty Mutual Research Institute for Safety.

3BLS [2018]. Injuries, Illnesses, and Fatalities. Chart 12: Incidence rate of injuries and illnesses with days away from work by selected event or exposure, all ownerships, 2013-17. Washington, D.C.: Department of Labor, Bureau of Labor Statistics, icon

4NIOSH [2015]. NIOSH Center for Workers’ Compensation Studies (CWCS). Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,

5Meyers AR et al [2018]. Applying machine learning to workers’ compensation data to identify industry-specific ergonomic and safety prevention priorities: Ohio, 2001 to 2011. JOEM 60(1):55-73.

6Lu M, Afanuh S, Dick R, Werren D, and Waters T [2017]. Reducing musculoskeletal disorders among airport baggage screeners and handlers. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2015-201,


About 20% of U.S. workers are over the age of 65.1 According to the NIOSH National Center for Productive Aging and Work (NCPAW), older workers may be more susceptible to MSDs (especially back pain), more likely to be hospitalized for MSDs, and more likely to have longer stays in the hospital for MSDs. MSDs, common among older workers, are a main contributor to the pain epidemic2 and have resulted in the overuse of opioids.3 The cost of preventing work-related MSDs can be expensive when you consider the needs of older workers. Traditionally, effective methods for minimizing MSD risk factors include reducing the weight of the load lifted and eliminating poor work posture for tasks through engineering or administrative controls and using ergonomic guidelines. With an increasing proportion of aging workers in the US working population, the traditional ways of risk controls may not be effective. To accommodate the full age range of the work force, businesses need comprehensive solutions that may involve the use of new risk assessment techniques or emerging risk control technologies, such as robotics, automation, exoskeletons and wearable sensors.


In light of the need to address what the NCPAW calls “the aging workforce phenomenon.” Robotics, automation, and exoskeletons (or human augmentation devices) can be used to improve safety and reduce the risk factors for MSDs. The introduction of robotics and automation in general are considered as labor saving devices that may reduce the number of overexertion injuries or MSDs in the workplace. Motion quantification-based wearable sensors may provide solutions to reducing the subjective biases of traditional observational-based ergonomic risk assessments, thereby, improving risk control strategies with more accurate risk assessment results.  Uses of these technologies are rapidly appearing in the workplace despite limited research on their effectiveness in reducing MSDs.  At present, there has been little research into the evaluation of emerging technologies.

It is believed that these new technologies have the potential to dramatically reduce the frequency and severity of MSDs in the workplace. However, research is needed to identify the costs and benefits of the intervention (including any productivity gains) using merging technologies. Translation research is also needed to identify the barriers to adoption; in many cases this data does not exist and needs to be collected. Regardless of the work system, interventions must be effective in how they reduce risk.


NIOSH published the guidance document “Observation-based Posture Assessment: Review of Current Practice and Recommendations for Improvement,” which helps practitioners assess working posture and prevent MSDs. NIOSH also published the guidance document “Elements of Ergonomics Programs” to provide basic intervention information and outline practical strategies for identifying and correcting ergonomic deficiencies in a variety of workplace settings. These and other research-based tools can help prevent work-related MSDs.

1NIOSH [2016]. Productive Aging and Work. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,

2Carnide N, Hogg-Johnsonexternal icon S, Côtéexternal icon P, Furlanexternal icon A, Irvinexternal icon E, Van Eerdexternal icon D, Kingexternal icon T [2011]. Early prescription opioid use for musculoskeletal disorders and work: A critical review of the literature. Occup Environ Med 68:A75

3DHHS [2016] National Pain Strategy: A comprehensive population health-level strategy for pain. Washington, DC: U.S. Department of Health and Human Services, iconexternal icon

Page last reviewed: September 23, 2019