Work-Related Musculoskeletal Disorders (WMSDs) Evaluation Measures

Once a company has conducted assessment and planning for work-related musculoskeletal disorders (WMSDs) prevention programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.

Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Work-related musculoskeletal disorders (WMSDs) 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 musculoskeletal disorders. Examples of work conditions that may lead to WMSDs 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 (e.g., hearing loss, occupational skin diseases such as dermatitis, eczema, or rash).

  • 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
  • The Institute of Medicine estimates of the economic burden of WMSDs, as measured by compensation costs, lost wages, and lost productivity, are between $45 and $54 billion annually3
  • The Bureau of Labor Statistics reported 26,794 Carpal tunnel syndrome cases involving days away from work in 20014
  • In 2001, the Bureau of Labor Statistics reported 372,683 back injury cases involving days away from work5
  • In 2003, the total cost for arthritis conditions was $128 billion—$81 billion in direct costs and $47 billion in indirect costs6
  • 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 arthritis7

Developing and Implementing Workplace Controls

Engineering controls, administrative controls and use of personal protective equipment

  • 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 such as changing workstation layout, which might include using height-adjustable workbenches or locating tools and materials within short reaching distances
  • Administrative control strategies are policies and practices that reduce WMSD risk but they do not eliminate workplace hazards such as changes in job rules and procedures such as scheduling more breaks to allow for rest and recovery. 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
  • Use of personal protective equipment (PPE)


Ergonomics  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.8 For example, employees who spend many hours at a workstation, may develop ergonomic-related problems resulting in musculoskeletal disorders (MSDs).

Of particular interest in evaluation of programs to prevent WMSDs is the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) Elements of Ergonomics Programs primer with seven steps to address WMSDs.9 Each step lends itself to an evaluation measure.

  1. Look for signs of a potential WMSD in the workplace, such as frequent worker reports of aches and pains or tasks requiring repetitive forceful exertions (health care costs, health outcomes) and act to reduce them
  2. Show management commitment by addressing possible problems and encouraging worker involvements in problem-solving activities (organizational change)
  3. Offer training to expand management and worker ability to evaluate potential WMSDs (health outcomes, organizational change)
  4. Gather data to identify jobs or work conditions that are most problematic, using sources such as injury and illness logs, medical records, and job analyses (health outcomes)
  5. Identify effective controls for tasks that pose a risk of WMSD and evaluate these approaches once they have been instituted to see if they have reduced or eliminated the problem (organizational change)
  6. Establish health care management to emphasize the importance of early detection and treatment of WMSDs for preventing impairment and disability (health outcomes)
  7. Minimize risk factors for WMSDs when planning new work processes and operations (organizational change)



1.  Bernard BP, editor. U.S. Department of Health and Human Services, Centers for Disease control and Prevention, National Institute of Occupational Safety and Health. Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and lower back. July 1997. DHHS (NIOSH) Publication No. 97-141. Available from:

2.  NIOSH workers health chartbook 2004. NIOSH Publication No. 2004-146. Washington, D.C.

3.  National Research Council and the Institute of Medicine (2001). Musculoskeletal disorders and the workplace: low back and upper extremities. Panel on Musculoskeletal Disorders and the workplace. Commission on behavioral and social sciences and education. Washington, DC: National Academy Press. Available from:

4.  Carpal tunnel syndrome (CTS). In: Chapter 2: Fatal and nonfatal injuries, and selected illnesses and conditions. In: Worker health chartbook 2004. NIOSH publication no. 2004-146. Washington, D.C.

5.  Back, including spine and spinal cord. In: Chapter 2: Fatal and nonfatal injuries, and selected illnesses and conditions. In: Worker health chartbook 2004. NIOSH publication no. 2004-146. Washington, D.C.

6.  Yelin E, Murphy L, Cisternas M, Foreman A, Pasta D, Helmick C. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons to 1997. Arthritis and Rheumatism 2007;56(5):1397-1407.

7.  Theis KA, Hootman JM, Helmick CG, Murphy LM, Bolen J, Langmaid G, Jones GC. State-specific prevalence of arthritis-attributable work limitation—United States, 2003. MMWR 2007; 56: 1045-1049.

8.  U.S. Department of Defense: Ergonomics Tech Guide 220: Booklet I, General Program Management.

9.  Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health. Elements of ergonomic programs: a primer based on evaluations of musculoskeletal disorders. 1997. DHHS (NIOSH) Publication No. 97-117. Available from: