Ergonomics

Peer-Reviewed

Musculoskeletal
Disorders
Five Common Management Approaches
By Walt Rostykus, Winnie Ip and James Mallon

N
o matter what you call them, force, and long duration and/or high fre-
cumulative trauma disorders, quency (Figure 1, p. 36), are well known,
repetitive motion injuries or and a substantial body of credible epi-
musculoskeletal disorders (MSDs), soft- demiological research provides evidence
tissue injuries continue to be a major of these associations (NIOSH, 1997a;
cause of loss in today’s workplace. In b). Although the limits for each of these
1713, Ramazzini (trans. 1964) made one risk factors vary by joint structure (e.g.,
of the first published mentions of these shoulder, wrist, back), increasing combi-
types of injuries as “diseases of those nations of these factors are tied to the in-
who do fine work.” In 1917, Hamilton creased risk of developing
(1943) described a disorder called “dead an MSD (NIOSH, 1997a;
fingers” affecting stone cutters using air b). This evidence-based
hammers to cut and shape limestone, cause-and-effect asso- IN BRIEF
one of the first published recognitions ciation provides a reliable tStrategies used to manage
of the effects of vibration on soft tissue. basis for effective MSD musculoskeletal injuries range
MSDs have continued to affect work- management. widely from reactive to proac-
ers over time. In the mid-1980s, safety In recent benchmark- tive, and are based on various
professionals and employers realized ing studies, employers approaches, including changing
that MSDs (a common term used in indicated that MSDs ac- personal wellness, fitness and
the U.S. for such injuries) were an in- count for 24% to 75% of employee work behaviors, and
creasing issue and began implementing their recordable injuries changing the workplace to bet-
controls. It is interesting to note that the (Humantech, 2011). Fur- ter fit employee capabilities.
terminology for MSDs is not universal. ther investigation reveals tThis article summarizes five
Boocock, Collier, McNair, et al. (2009), that the strategies used commonly used approaches by
reviewed literature from 15 countries to manage these injuries examining the pros and cons
and found that the terminology used range widely from reactive for each, and the investment
to describe MSD conditions in upper to proactive, and are based needed and value returned of
extremities lacked international con- on various approaches, each. Their effectiveness and
sensus, which can add challenges when including changing per- application in industry are
managing these disorders across global sonal wellness, fitness and reviewed as well.
organizations. employee work behaviors,
Fortunately, the risk factors that cause and changing the work-
MSDs, primarily awkward posture, high place to better fit employee capabilities.

Walt Rostykus, M.S.P.H., CSP, CIH, CPE, is a vice president with Winnie Ip, M.B.A., CPE, is director of consulting at Humantech Inc.
Humantech Inc. with more than 30 years’ experience delivering and in Ann Arbor, MI. She holds a B.S. in Kinesiology from the Uiversity
managing ergonomic, occupational safety, industrial hygiene and of Waterloo and an M.B.A. from the University of Western Otntario.
environmental programs. He holds a B.S. from Washington State Ip is a member of ASSE’s Greater Detroit Chapter and she is the
University and an M.S. in Public Health, with a focus on industrial publications coordinator for the Ergonomics Practice Specialty.
hygiene and safety/environmental health and sanitation, from the
James Mallon, M.S., M.B.A., CPE, is executive vice president at
University of Washington. Rostykus is a professional member of
Humantech Inc. He holds a B.S. in Kinesiology and an M.S. from
ASSE’s New Mexico Chapter, Assistant Administrator of the Society’s
Dalhousie University, and an M.B.A. from the University of Western
Ergonomics Practice Specialty, a member of AIHA and an affiliate
Ontario. Mallon is a member of the Human Factors and Ergonomics
instructor at the University of Washington.
Society and a member of ASSE’s Greater Detroit Chapter.

www.asse.org DECEMBER 2013 ProfessionalSafety 35

 Through benchmarking lationships and coordination between medical staff
Figure 1 studies, work with global com- and those conducting investigations. Physical and
Primary MSD panies and review of published
research and articles, the au-
occupational therapists may also be engaged to as-
sist with treatment and return-to-work processes.
Risk Factors thors and colleagues identified
various approaches used to ad-
These healthcare professionals diagnose and treat
individuals of all ages with medical problems or
dress and control MSDs, then other health-related conditions that limit their
selected the top five most com- abilities to move and perform functional activities
mon approaches: in their daily lives (American Physical Therapy As-
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approach, and contrasts their has occurred;
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that cause MSDs fessionals’ perspectives and understanding of MSD only aims to minimize it;
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widely researched. new opportunities to better manage these losses. a time.
This approach provides value in that it helps treat
Common Approach #1: Fix the Person the injured employee and reduce associated costs
When an employee experiences an MSD or of recovery. The investment in time and services is
sprain/strain injury, an employer must provide the high (medical and return-to-work expenses); actu-
injured employee with diagnosis and treatment, al cost and treatment requirements are not well de-
then manage the return-to-work process. This is fined initially; and the approach does not identify
medical management, a reactive program designed or address the next source of MSD injury (preven-
to care for injured employees and reduce losses tion). However, reactive programs are essential for
(time and financial) related to the injuries. responding to any injury, including MSDs, when
Medical management applies to all workplace they occur.
injuries and illnesses, not just MSDs. Typically, Relying solely on this model may be the only
this approach depends on and is best supported approach that works for organizations with non-
by healthcare providers (occupational nurses and standard work tasks, high employee turnover, no
doctors) qualified in occupational health and MSD available internal resources (safety personnel or
management. Fortunately, healthcare providers engineers), and little opportunity to influence tool
experienced and qualified in MSD diagnosis and and workstation design.
treatment follow established, common and accept-
ed protocols (Decina & Bojanic, 1993; Herington & Common Approach #2: Fit the Person to the Task
Morse, 1995). To reduce the incidence of strain injuries, many
This approach of diagnosis, treatment and return organizations try to match a current or prospective
to work is focused on attending to the individual employee’s capabilities to the physical demands of
worker’s needs. The process used, as well as its the workplace—in other words, fit the person to
effectiveness and efficiency, can be greatly influ- the task. This approach relies on measuring a per-
enced (positively or negatively) by several other son’s functional capacities (e.g., strength, reach,
operational factors, including the system for fund- range of motion, maximal oxygen consumption),
ing and tracking occupational injuries (workers’ then matching the person to requirements of the
compensation system or government-sponsored work as determined by the findings of a physical
healthcare); method and requirements for classify- demands analysis.
ing workplace injuries; speed of injury reporting; This is a preventive approach. Employers must
aggressiveness of treatment and return to work; invest additional time and services to conduct
and ability to find/accommodate tasks for return- functional capacity analyses and prework screen-
to-work programs and resolve injury causes. ing exams to match the physical demands of each
All employers should at least have a system for job description. The approach typically requires
the medical management of MSDs. This reactive hiring physical or occupational therapists to con-
approach is most effective when the program in- duct a functional capacity exam (FCE) to “provide
tegrates immediate and detailed injury/illness an objective measure of a patient’s/client’s safe
investigations to find injury causes and initiates functional abilities compared to the physical de-
corrective action. An effective medical manage- mands of work” (American Physical Therapy As-
ment program typically features strong working re- sociation, 2013).
36 ProfessionalSafety DECEMBER 2013 www.asse.org
 Proof that this approach is effective ranges from cupational Health Clinics for Ontario Workers Inc.
anecdotal reports in trade magazines and on web- (2013) when returning injured employees to work.
sites to published research studies. The results of In this case, matching the person to the task is part
studies vary widely, ranging from “no difference” of a return-to-work program.
to “significantly lesser” to “prevents 47% of future Organizations that use this approach are typically To find
MSD (and other) injuries,” provided the physical engaged in manual material handling and field tasks the right
demands and functional capacity tests are accurate that provide limited control over workplace condi- combination
representations of exposures at work (Anderson & tions (e.g., warehousing, stocking and order pick-
Briggs, 2008; Dueker, Ritchie, Knox, et al., 1994; ing, driving and delivery tasks, emergency services). of approach-
Rosenblum & Shankar, 2006). In a review of nine es, a com-
published studies, Mahmud, Schonstein, Schaaf- Common Approach #3: Change the Person pany must
sma, et al. (2008), conclude that “there is very Some organizations aim to prevent MSDs
low quality evidence that preemployment exami- through activities designed to change an individu- consider
nations that are specific to certain jobs or health al’s capabilities, fitness and stamina. This is an in- many factors,
problems could reduce occupational disease, injury vestment in employees’ fitness and wellness. including site
or sickness absence.” American College of Occupational and Environ-
A job-matching program should involve both hu- mental Medicine (ACOEM, 2011) promotes the culture,
man resources personnel and a qualified healthcare concept of integrated health protection (safety) and amount of
provider (physician, occupational therapist, physical promotion (wellness) in the workplace. This ap- workplace
therapist); use reliable and valid methods for con- proach is not focused just on MSDs, but on overall
ducting FCEs and physical demands analyses; and employee health and wellness. control,
require basic knowledge of federal and state em- Some organizations rely on stretching, exercise ability to
ployment law because a fine line exists between job and conditioning programs (alone or in combina- change the
placement and discrimination. The Americans With tion with other interventions) to change an indi-
Disabilities Act does not prevent employers from vidual worker’s physical condition with the aim of workplace
conducting physical agility and physical fitness tests preventing MSDs. This approach relies on changing and
on employees or job applicants. However, employ- each employee’s physical condition and capabilities, available
ers cannot require medical examinations unless they and depends on many variables that are outside an
are shown to be job-related and consistent with employer’s control, including employee willingness, resources.
business necessity. interest and participation; an individual’s physical
Thus, a job applicant can be subjected to medical condition and preexisting conditions; and the de-
examinations only after s/he first receives a condi- sign of the exercises to match workplace demands.
tional offer of employment that cannot be revoked In the U.S., employers that use exercise and
unless the examination demonstrates that the appli- stretching to manage MSDs must ensure that they
cant is unable to safely perform all of the position’s are promoting preventive exercise, not therapeu-
essential job functions (Zuccarello & Paul, 2011). tic exercise. OSHA (2010) interprets therapeutic
Benefits of this approach include the following: stretching as follows: “If a physician or licensed
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candidate’s preexisting conditions. exercise in response to a work-related injury or
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Many studies have examined the effects of
the demands of their workplace and tasks. stretching on the performance of athletes, and most
The drawbacks are that it: results have been generally positive. However, the
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workplace and physical condition of employees
in the U.S. to avoid violating the Americans With (and an employer’s control of employee physical
Disabilities Act; condition) are different. In a review of three stud-
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ies, Hess and Hecker (2003) conclude that the re-
screening by a qualified professional; sults suggest that worker health was enhanced and
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studies “failed to definitively prove the case for or
reflect the physical demands of the entire job task; against stretching.”
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place; the same conclusions that results were “not very
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Starting in the 1960s and continuing into the McGorry & Courtney, 2006; Silverstein & Clark,
early 1980s, many employers favored the practice 2004). Choi and Woletz (2010) conclude that “while
of matching employee capability to task condi- research does support that stretching improves
tions, but its popularity appears to be waning. flexibility, range of motion (ROM) and self-worth,
In the authors’ experience, 10% to 30% of U.S. stretching alone might not prevent work-related
companies still use this approach. In addition, it musculoskeletal disorders and injuries.”
is encouraged in parts of Canada, where physical Although some companies mandate stretching
demands analyses are recommended by the Oc- before and during work, many state that it is chal-
www.asse.org DECEMBER 2013 ProfessionalSafety 37
 lenging to get people to participate in (and continue The exercise and stretching approach works well
with) these programs. In an early study on the ef- for organizations with limited ability to change
fects of exercise on MSDs, Silverstein, Armstrong, workplace setup and configuration, the flexibility
Longmate, et al. (1988), report that only 41% of the to interrupt work and devote time to exercise, a
study group participated in the exercise program strong team culture, and a strong commitment to
daily, while 28% had discontinued all participation. and investment in employee wellness and fitness.
Exercise programs alone will not reduce MSDs. This approach is used regularly in construction,
Proponents of stretching and conditioning iden- baggage handling, package delivery, heavy assem-
tify that these fitness-based approaches are effec- bly and manufacturing settings.
tive only when combined with other interventions
(Liberty Mutual Group, 2009; McGorry & Court- Common Approach #4:
ney, 2006). Many results published in trade maga- Change How a Person Performs Work
zines and on the Internet share anecdotal cases of Some employers also endeavor to change how
organizations reporting a 15% to 80% reduction in people behave or perform work tasks to reduce
injuries over the course of a long-term stretching exposure to MSD risk factors. This approach relies
program. Finally, the activities of any stretching or on behavioral modification, typically through be-
conditioning protocol should be tailored to tasks havior-based safety (BBS) programs, work practice
performed and physical demands presented (task-/ training and awareness campaigns that stress and
job-specific stretches). Companies must also be reinforce the use of proper body mechanics.
mindful of preexisting conditions and tailor exer- SH&E professionals know that behavioral safety
cise and stretching protocols accordingly. Generic is an administrative control that should be ad-
programs can exacerbate issues if the stretches are opted only after engineering controls (workplace
counter to the physical demands of the work. changes) have been implemented and exposures
Reported returns on investment from stretch- to workplace hazards have been reduced to the
ing programs vary greatly. For example, Hess and lowest level achievable. This behavioral approach
Hecker (2003) evaluated one study and conclude relies primarily on employees changing their per-
that the “cost-benefit of stretching in workplaces ceptions of work and risk, changing how they per-
where ‘time is money’ is negative.” form work, overcoming existing work practices,
Potential advantages of stretching, fitness and and sustaining these changes throughout the work
conditioning activities are that they are: shift, work week and their careers.
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even martial arts experts, all providing services and
work; systems to train employees in the use of body me-
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al physical fitness. found no concrete evidence of the effectiveness of
Drawbacks are that such activities: this approach in reducing MSDs. However, several
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ries (high forces and weights, awkward postures); approaches in reducing overall injuries (not specific
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to MSDs). For example, in a review of published
from work; studies, Goggins, Spielholz and Nothstein (2008)
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report that the cost effectiveness for MSD reduc-
chance of injury; tion realized by companies relying on behavior
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change is only 10% to 20%.
(e.g., employee time, program development, pro- The advantages of this approach include:
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ergonomic behavioral/movement program sepa-
business cycle changes; rate from a comprehensive BBS program requires
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have no control over employees’ preexisting con- from work and are doing something different).
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tional therapists. Athletic trainers are “healthcare behaviors do change, they rarely have a significant
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clients. Athletic training encompasses the preven- shows that cost effectiveness is low (10% to 20%)
tion, diagnosis and intervention of emergency, (Goggins, et al., 2008).
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(National Athletic Trainer’s Association, 2013). t*U
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38 ProfessionalSafety DECEMBER 2013 www.asse.org
 t.BOBHFST
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HFU- and high frequency and/or long duration (NIOSH,
ting people to participate in the programs and to 1997). The limits for each factor vary by each joint
use safe work practices, which requires additional of the body due to its anatomical structure. A com-
management time and effort to enforce. bination of two or more risk factors increases the
This approach works well for organizations that chance of developing an MSD. Valid and proven By practic-
cannot or choose not to change the workplace, assessment tools are available for whole-body ex- ing good
have time available to teach and engage employ- posure, as well as segmental exposure and specific ergonomic
ees, and have an existing behavioral safety ob- risk factors.
servation program. It is also frequently used in Effective assessment tools use quantitative mea- design,
organizations with nonstandard work environ- sures to identify and determine the exposure to risk employers
ments. Several strong programs exist in the hotel/ factors that contribute to MSD development (Mar- will provide
motel and entertainment services industry; distri- ras, Allread, Burr, et al., 2000; Marras, Fine, Fergu-
bution, packaging and cartage tasks; trucking and son, et al., 1999; Paquet, Punnett & Bucholz, 2001; a work-
delivery operations; and construction. Törnström, Amprazis, Christmansson, et al., 2008). place that
For example, the NIOSH lifting equation is used reduces
Common Approach #5: Change the Work & Workplace to evaluate the back during lifting tasks while the
Occupational ergonomics involves changing rapid entire body assessment is used to evaluate exposures
the workplace and work design to fit the people exposures to all joints of the body. to MSD
performing the work. NIOSH (1997) defines oc- The usability of qualitative and quantitative as- risk factors.
cupational ergonomics as “the science of fitting sessment tools has evolved to a point at which
workplace conditions and job demands to the ca- nonsafety, ergonomics or medical professionals
pabilities of the working population.” This engi- can conduct MSD risk assessments effectively. In
neering- and design-based definition is consistent one study, Winnemuller, Spielholz, Daniell, et al.
with other internationally recognized professional (2004), found that 81% of supervisors and 77% of
associations and organizations (e.g., Board of Cer- workers completed ergonomic risk assessments
tification in Professional Ergonomics, International that were in agreement with those completed by
Labor Organization). an ergonomist. The bottom line is that MSD as-
The concept of designing workplace conditions sessment and management can and should include
and job demands to fit workers’ capabilities aligns people across an organization, not just an ergo-
with the OSH Act’s General Duty Clause, which re- nomics professional.
quires employers to “furnish to each of his employ- Changing the workplace depends on people in
ees employment and a place of employment which engineering roles (e.g., engineers, maintenance
are free from recognized hazards that are causing personnel) and engineering controls (adjustments
or are likely to cause death or serious physical harm and changes in the physical workplace) to ensure
to his employees.” Simply put, by practicing good that reach, force and distance are within accept-
ergonomic design, employers will provide a work- able limits of the collective workforce. This requires
place that reduces exposures to MSD risk factors. designing the workplace to fit the 5th percentile
The approach to managing ergonomics in the female to the 95th percentile male to prevent ex-
workplace has changed significantly from the early posure to MSD risk factors for all workers. Many
days when OSHA (1991) released its “Ergonomics studies have proven this approach to be effective
Program Management Guidelines for Meatpack- and efficient (Douphrate & Rosecrance, 2004; Gi-
ing Plants.” This guide was a common resource for lad & Einekave, 2007; Ip, 2009).
safety professionals beginning to address MSDs. A Administrative controls include changes to work
common current practice is to manage workplace planning, such as job rotation, rest breaks and
ergonomics by focusing proactively on identify- slowed pace. These controls depend on people
ing and reducing the risk factors that cause MSDs and can create additional challenges for managers
(NIOSH, 1997). and supervisors as they try to rotate employees or
This approach follows the continuous improve- change their work tasks. Furthermore, administra-
ment process of plan-do-check-act: assess the risk, tive controls do not reduce or eliminate the pres-
implement controls, validate their effectiveness ence of MSD risk factors; they simply reduce the
and standardize the controls. This approach has exposure time (high frequency or long duration)
been adopted and promoted by Brazil (NR-17), when managed correctly by exposing more people
Canadian Standards Association (2012) and AIHA to the risk factors for shorter periods of time. Job
(2008) (Santos & Neto, 2012). Regardless of the rotation will not prevent MSDs (Triggs & King,
model on which a program is based, “the main fo- 2000). In addition, Schneider, Davis and Jorgensen
cus of a comprehensive ergonomics program is to (2005) caution that since the objective of a job rota-
make tasks, jobs, products, environments and sys- tion scheme is to minimize the risk to all workers,
tems compatible with the needs, abilities and limi- not just one specific worker, it may fail if the expo-
tations of people, as opposed to making the people sures to all MSD risk factors across all body regions
compatible with the work characteristics and de- are not adequately balanced.
mands” (Costa & Vieira, 2008). Goggins, et al. (2008), reviewed 250 published
Diagnosis is the first step to identify and measure case studies on the reported benefits of ergonom-
workplace exposures to MSD risk factors. The pri- ics programs and control measures. Their findings
mary risk factors are awkward posture, high force, validate the hierarchy of controls as applied to im-
www.asse.org DECEMBER 2013 ProfessionalSafety 39
 Research and laboratory settings; and
validates the Figure 2 heavy manufacturing.
hierarchy of
controls as Cost Effectiveness of Beyond that, several or-
ganizations have standard-
applied to
improving
MSD Risk Factor Controls ized the proactive approach
of managing ergonomics and
ergonomic have moved upstream to an
conditions in advanced level. Advanced
the workplace. operations are characterized
by evaluating the ergonomics
of future products, processes,
tools, offices and layouts, and
designing future operations to
fit the capabilities of those who
will work there.
Simply put, this is preven-
tion through design. It requires
the ergonomics process to be
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These researchers found that the cost effectiveness working population and prevent the introduction
of several MSD controls were as follows (Figure 2): of MSD risk factors in the next-generation work-
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trols, or breaks and rotation): 20% to 40%. the following:
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Support and engagement in effective ergonom- controlled before an injury and loss occurs.
ics processes depend on involvement by people t3JTL
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DPOUSPMT
CFOFmU
BMM
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across an organization. Ergonomics/safety teams ing at a task, now and in the future.
effectively conduct assessments. Employees bring t&OHJOFFSJOH
DPOUSPMT
BSF
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PWFS
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expertise to cross-functional teams working on positively affect employee behaviors and perfor-
controls that reduce exposure to MSD risk factors. mance, and reduce the need for BBS program ele-
Engineering and administrative controls are best ments.
supported by engineers, maintenance personnel t$POUSPMT
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and professionals qualified in ergonomics. on employee behaviors.
Many organizations are working toward or have t&NQMPZFF
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achieved a proactive ergonomics process to iden- sures buy-in and change.
tify and manage exposures to work-related MSD t"
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risk factors. Such organizations have utilized the Although expense and capital costs accompany en-
other approaches discussed, but have not achieved gineering controls, this investment is significantly
desired results. They have control over their work- lower than the costs of later MSD claims.
place to make changes, and the necessary attitude In addition, several challenges must be overcome:
and support. In addition, these are organizations t1FSDFQUJPOT
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that can and do change the workplace to reduce t&OHJOFFST
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changes, realize that the investment in equipment t'VOEJOH
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and changes will pay off, and integrate the change
process into their normal methods of business. The Right Approach for Each Organization
In a review of 45 empirical studies, Neuman and The key is to find the right fit for some or all
Dul (2010) conclude that applying ergonomics (hu- of these approaches within an organization. Fit
man factors) in operations system design supports is based on many factors, including site culture,
improvement in both employee well-being and amount of workplace control, ability to change the
system performance in several manufacturing do- workplace, available resources and resource com-
mains. Examples of organizations applying ergo- mitment.
nomics to manage MSDs include offices and call Another way to consider these approaches is to
centers; production and manufacturing facilities; compare them with the maturity of the MSD man-
processing, fleet and delivery operations; healthcare agement program. Through a series of benchmark-
40 ProfessionalSafety DECEMBER 2013 www.asse.org
ing studies, Humantech (2011) has identified four
general levels of program maturity through which References
companies progress as they improve the effective- AIHA. (2008). Ergonomics program guidance docu-
ness and efficiency of managing MSDs (Figure 3). ment: Aligned with ANSI/AIHA Z10-2005. Fairfax, VA:
The five approaches discussed align with the Author.
maturity curve levels: American College of Occupational and Envi-
ronmental Medicine (ACOEM). (2011). Workplace
Maturity Curve Level Approach health protection and promotion: A new pathway for a
healthier—and safer—workforce. Journal of Occupational
3FBDUJWF
t'JY
UIF
QFSTPO and Environmental Medicine, 53(6), 696-702.
American Physical Therapy Association. Role of a
1SFWFOUJWF
t'JU
UIF
QFSTPO
UP
UIF
UBTL
physical therapist. Retrieved from www.apta.org/

t$IBOHF
UIF
QFSTPO PTCareers/RoleofaPT

t
$IBOHF
IPX
UIF
QFSTPO
Amick, B.C., Brewer, S., Tullar, J.M., et al. (2009,
QFSGPSNT
XPSL March). Musculoskeletal disorders: Examining best
1SPBDUJWF
t
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UIF
DVSSFOU

practices for prevention. Professional Safety, 54(3), 24-28.
XPSL
BOE
XPSLQMBDF Anderson, C. & Briggs, J. (2008). A study of the
effectiveness of ergonomically based functional screen-
"EWBODFE
t
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UIF
GVUVSF

XPSL
ing tests and their relationship to reducing workers’
BOE
XPSLQMBDF compensation injuries. Work, 31(1), 27-37.
Board of Certification in Professional Ergonom-
ics. (2013). Candidate handbook: Certification policies,
Many approaches are available for managing
practices and procedures. Retrieved from http://admin
MSDs in the workplace. A right fit exists for every .bcpe.org/system/assets/bcpehq/documents/BCPE
organization, depending on current needs, work _CHB_Modified_Feb13.pdf
environment, company culture, teamwork and en- Boocock, M.G., Collier, J.M., McNair P.J., et al.
gagement, support resources, improvement goals (2009). A framework for the classification and diagnosis
and workplace exposures. A company may apply of work-related upper extremity conditions: Systematic
one, several or all of the reviewed approaches. review. Seminars in Arthritis and Rheumatism, 38(4),
Researchers continue to investigate the effective- 296-311.
ness of each strategy. Most researchers continue to Bowers, B.A. (2010, Aug.). Work conditioning. Pro-
recommend that any strategy include the system- fessional Safety, 55(8), 24-28.
Canadian Standards Association. (2012). Work-
atic application of ergonomics (administrative and place ergonomics: A management and implementa-
engineering controls) (Amick, Brewer, Tullar, et al., tion standard (CSA Standard Z1004-12). Mississauga,
2009; Bowers, 2010; Hess & Hecker, 2003; McGorry Ontario: Author.
& Courtney, 2006; Silverstein & Clark, 2004; Triggs Charlton, S.G. & O’Brien, T.G. (2002). The role of
& King, 2000). The final strategy described, chang- human factors testing evaluation in systems develop-
ing the workplace, continues to be the most effec- ment (pp. 21-36). In T.G. O’Brien and S.G. Charlton
tive, efficient and sustainable approach. When done (eds.), Handbook of human factors testing and evaluation.
well, an organization becomes less reliant on the Mahwah, NJ: Lawrence Erlbaum Associates.
other approaches. PS Choi, S.D. & Woletz, T. (2010, Winter). Do stretch-
ing programs prevent work-related musculoskeletal
disorders? Journal of Safety, Health & Environmental
Research, 6(3).
da Costa, B. &
Figure 3 Vieira, E. (2008)

MSD Program Maturity Curve

Stretching to reduce
work-related muscu-
loskeletal disorders:
A systematic review.
Journal of Rehabilita-
tion Medicine, 40,
321-328.
Decina, M.M. &
Bojanic, I. (1993).
Overuse injuries of the
musculoskeletal system.
Boca Raton, FL: CRC
Press.
Douphrate, D. &
Rosecrance, J. (2004).
The economics and
cost justification of
ergonomics. Retrieved
from http://ergo
.mech.utah.edu/
pages/NORA/2004
/29-40_Douphrate
David.pdf
www.asse.org DECEMBER 2013 ProfessionalSafety 41
 Dueker, J.A., Ritchie, S.M., Knox, T.J., et al. (1994). NIOSH. (1997b). Musculoskeletal disorders and
Isokinetic trunk testing and employment. Journal of Oc- workplace factors: A critical review of epidemiologic evi-
cupational Medicine, 36(1), 42-48. dence for work-related musculoskeletal disorders of the
Gilad, I. & Elnekave, M. (2006). Inserting cost ef- neck, upper extremity and low back. Washington, DC:
fectiveness to the ergonomic equation when considering U.S. DHHS, Public Health Services, CDC, Author.
practical solutions. International Journal of Production Occupational Health Clinics for Ontario Workers
Research, 44(24), 5415-5441. Inc. Physical demands analysis. Retrieved from www
Goggins, R., Spielholz, P. & Nothstein, G. (2008). .ohcow.on.ca/uploads/Resource/General%20Hand
Estimating the effectiveness of ergonomics interven- outs/Physical%20Demands%20Analysis.pdf
tions through case studies: Implications for predictive OSHA. (1991). Ergonomics program management
cost-benefit analysis. Journal of Safety Research, 39(3), guidelines for meatpacking plants (OSHA Report 2023).
339-344. Washington, DC: U.S. Department of Labor, Author.
Hamilton, A. (1943). Exploring the dangerous trades: OSHA. (2010, May 21). Therapeutic exercise is
The autobiography of Alice Hamilton. Boston, MA: Little, considered medical treatment for recordkeeping
Brown and Co. purposes [1904.7;1904.7(b)(5)(ii)(M)] (Letter of standard
Herington, T.N. & Morse, L.H. (1995). Occupational interpretation). Retrieved from www.osha.gov/pls/
injuries, evaluation, management and prevention. St. Louis, oshaweb/owadisp.show_document?p_table=inter
MO: Mosby. pretations&p_id=27674
Hess, J. & Hecker, S. (2003). Stretching at work for OSHA. (2011, May 20). Clarification on whether an
injury prevention: Issues, evidence and recommenda- exercise regime is first aid or medical treatment (Letter
tions. Applied Occupational and Environmental Hygiene, of standard interpretation). Retrieved from www.osha
18(5), 331-338. .gov/pls/oshaweb/owadisp.show_document
Humantech Inc. (2011). Summary of benchmarking ?p_table=interpretations&p_id=27698.
study results: Elements of effective ergonomics program Paquet, V., Punnett, L., & Buchholz, B. (2001). Va-
management. Retrieved from www.humantech.com/ lidity of fixed-interval observations for postural assess-
resources/White_Paper_2011_Ergo_Pgm__Mgt ment in construction work. Applied Ergonomics, 32(3),
__Benchmarking_Summary.pdf 215-224.
International Labor Organization. (1997). Prevent- Ramazzini, B. Diseases of workers. Translated from
ing workplace injuries and illnesses through ergonom- the Latin text De Mortis Artificum of 1713 by W.C.
ics. World of Work, 21, 5-8. Wright. New York, NY: Hafner Publishing Co., 1964.
Ip, W. (2009). ROI of ergonomic improvements: Rosenblum, K.E. & Shankar, A. (2006). A study on
Demonstrating value to the business. Proceedings of the effects of isokinetic preemployment physical capa-
ASSE’s Safety 2009, San Antonio, TX, USA. bility screening in in the reduction of musculoskeletal
Lamba, A. (2013, Jan.). Designing out hazards in the disorders in a labor intensive work environment. Work,
real world. Professional Safety, 58(1), 34-40. 26(6), 215-228.
Liberty Mutual Group, Colorado Casualty. (2009). Santos, C. & Neto, P. (2012). Ergonomics and qual-
Worksite exercise programs and control of upper ity: An ergonomic quality assessment model for the
extremity musculoskeletal disorders. Loss Prevention workstation using the parameters established under the
Reference Note LP5067 CCI R5. Retrieved from http:// Brazilian regulations on ergonomics (NR-17). Work, 41,
bit.ly/1iKoq72 6087-6093.
Mahmud, N., Schonstein, E., Schaafsma, F., et al. Schneider, S., Davis, K. & Jorgensen, M. (2005).
(2010). Preemployment examinations for preventing Ergonomics: Pros and cons of job rotation as a means of
occupational injury and disease in workers. Cochrane reducing injury costs. Journal of Occupational and Envi-
Database of Systematic Reviews, 8(12), CD008881. ronmental Hygiene, 2(1), D1-D3.
Marras, W., Allread, W., Burr, D., et al. (2000). Pro- Shewhart, W.A. (1986). Statistical method from the
spective validation of a low-back disorder risk model viewpoint of quality control. Mineola, NY: Dover.
and assessment of ergonomic interventions associated Silverstein, B., Armstrong, T., Longmate, A., et al.
with manual materials handling tasks. Ergonomics, (1988). Can in-plant exercise control musculoskeletal
43(11), 1866-1886. symptoms? Journal of Occupational Medicine, 33(12),
Marras, W., Fine, L., Ferguson, S., et al. (1999). The 922-927.
effectiveness of commonly used lifting assessment Silverstein, B. & Clark, R. (2004). Interventions to
methods to identify industrial jobs associated with reduce work-related musculoskeletal disorders. Journal
elevated risk of low-back disorders. Ergonomics, 42(1), of Electromyography and Kinesiology, 14(1), 135-152.
229-245. Törnström, L., Amprazis, J., Christmansson, M., et
McGorry, R. & Courtney, T. (2006, April). Worksite al. (2008). A corporate workplace model for ergonomic
exercise programs. Professional Safety, 51(4), 25-30. assessments and improvements. Applied Ergonomics,
National Athletic Trainers’ Association. (2013). 39(2), 219-228.
What do athletic trainers do? Retrieved from www Triggs, D. & King, P.M. (2000, Feb.). Job rotation:
.nata.org/athletic-training An administrative strategy for hazard control. Profes-
Neumann, W.P. & Dul, J. (2010). Human factors: sional Safety, 45(2), 32-34.
Spanning the gap between OM & HRM (Research Winnemuller, L.L., Spielholz, P.O., Daniell, W.E.,
Paper ERS-2010-020-LIS). Rotterdam, Netherlands: et al. (2004). Comparison of ergonomist, supervisor and
Erasmus Research Institute of Management. worker assessments of work-related musculoskeletal
NIOSH. (1997a). Elements of ergonomics programs: risk factors. Journal of Occupational and Environmental
A primer based on workplace evaluations of musculo- Hygiene, 1(6), 414-422.
skeletal disorders. Washington, DC: U.S. Department Zuccarello, V. & Paul, J.M. (2011). Functional
of Health and Human Services (DHHS), Public Health capacity evaluations and return to work. The Monitor,
Services, CDC, Author. 10(2), 4-9.

42 ProfessionalSafety DECEMBER 2013 www.asse.org

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