Date: Jan. 17, 2001
Contacts: Vanee Vines, Media Relations Associate
Mark Chesnek, Media Relations Assistant
(202) 334-2138; e-mail <>

Some Jobs Increase Risk for Musculoskeletal Disorders;
Intervention Programs Can Be Effective

WASHINGTON -- Scientific evidence shows that musculoskeletal disorders of the lower back and upper extremities can be attributed to particular jobs and working conditions -- including heavy lifting, repetitive and forceful motions, and stressful work environments, says a new report from the National Research Council and the Institute of Medicine of the National Academies. Each year, these disorders affect about 1 million workers and cost the nation between $45 billion and $54 billion in compensation expenditures, lost wages, and decreased productivity. But the problem can be reduced with well-designed intervention programs.

"Scientifically based prevention efforts can be effective in the workplace, substantially reducing the risk of job-related musculoskeletal disorders," said Jeremiah A. Barondess, chair of the panel that wrote the report and president of the New York Academy of Medicine, New York City. "However, the connection between the workplace and these disorders is complex, partly because of the individual characteristics of workers -- such as age, gender, and lifestyle."

Lower back pain, tendinitis, nonspecific wrist complaints, and carpal tunnel syndrome are among the disorders that have considerable social and economic impact, with back pain making up the overwhelming share of reported problems. Scientific evidence and industry data strongly indicate that properly implemented strategies to reduce the incidence, severity, and consequences of work-related musculoskeletal disorders can be effective, the panel said. A magic bullet does not exist, but successful programs can be found in a variety of job settings, and they take into account procedures, equipment, and characteristics specific to the organization. Furthermore, these programs usually involve a high level of commitment from employers and employees.

Musculoskeletal disorders, or MSDs, is the medical term that refers to health problems affecting muscles, nerves, spinal disks, joints, cartilage, tendons, and ligaments. Many of these disorders occur in the lower back and upper extremities, which include the shoulders, arms, and hands. When the Occupational Safety and Health Administration began making plans to implement regulations covering MSDs in the workplace, Congress asked the National Academies to review scientific evidence on work-related causes of MSDs as well as prevention strategies. The Academies' panel evaluated scientific literature on the topic, invited outside experts to share insights at its meetings, and visited two Ford Motor Co. plants as part of its research.

There is a strong relationship between back disorders and jobs where workers manually lift materials, frequently bend and twist their bodies, or experience whole-body vibration from motor vehicles, the report says. A rapid work pace, monotonous work, low job satisfaction, little decision-making power, and high levels of job stress also are associated with back disorders. Such psychosocial factors affect not only how workers view themselves in relation to the workplace, but also the physical, organizational, and social aspects of their jobs.

For upper-extremity disorders, repetition, force, and vibration are important risk factors, the report says. In addition, highly demanding and stressful work environments are consistently associated with the occurrence of this type of MSD.

Among men, those who work as construction laborers, carpenters, and operators of industrial truck or tractor equipment are at the highest risk for developing MSDs. For women, the highest-risk jobs are in nursing or nursing support, and in domestic or commercial cleaning and janitorial work. But musculoskeletal disorders are a problem in many industries -- from agriculture, manufacturing, and mining to finance, the service sector, and transportation, the report says. Gender and age differences also appear to play a role in some musculoskeletal disorders.

Americans make nearly 70 million visits to physicians' offices each year seeking treatment for MSDs. In 1999 alone, nearly 1 million U.S. workers took time off because of work-related disorders of the lower back and upper extremities, either to receive medical care or for recuperation, the panel noted.

Although general principles to reduce the risk of work-related MSDs can be used to develop intervention strategies, programs must be tailored to specific workplaces, the report says. And these programs must be evaluated over time. More broadly, rigorous methods should be developed to compare outcomes of various intervention efforts.

Because the nation lacks a uniform and comprehensive method to gather and track data on MSDs, a coordinated and standardized data-collection system is needed, the report adds. To that end, the Bureau of Labor Statistics should provide more comprehensive surveillance of work-related MSDs by obtaining from employers specific information about jobs, workplace illnesses, and the characteristics of workers performing certain jobs. Standardized coding procedures and more precise and consistent descriptions of risk factors also should be developed for large data systems.

The report calls on the National Institute of Occupational Safety and Health to expand the scope of its research and training activities, and to take the lead in creating definitions of musculoskeletal disorders for research and other purposes -- measures that would require funding increases.

With one exception, the panel unanimously endorsed all of the conclusions and recommendations in the report. Panel member Robert M. Szabo, in a separate statement, objected to interpretations of the scientific literature on carpal tunnel syndrome and on the value of intervention efforts. The statement is included in the report.

The study was sponsored by the U.S. Department of Health and Human Services. The Research Council -- the principal operating arm of the National Academy of Sciences and the National Academy of Engineering -- and Institute of Medicine are private, nonprofit institutions that provide science and health policy advice under a congressional charter. A panel roster follows.

Read the full text of Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities for free on the Web, as well as more than 1,800 other publications from the National Academies. Printed copies are available for purchase from the National Academy Press Web site or at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News and Public Information at the letterhead address (contacts listed above).

Behavioral and Social Sciences and Education Division
Health Sciences Policy Division

Panel on Musculoskeletal Disorders and the Workplace

Jeremiah A. Barondess, M.D.* (chair)
New York Academy of Medicine
New York City

Mark R. Cullen, M.D.*
Professor of Medicine and Public Health
Occupational and Environmental
Medicine Program
Yale University School of Medicine
New Haven, Conn.

Barbara J. de Lateur, M.D., M.S.*
Professor, Director, and Lawrence Cardinal Shehan Chair
Department of Physical Medicine and Rehabilitation
Johns Hopkins University School of Medicine

Richard A. Deyo, M.D., M.P.H.
Professor of Medicine and of Health Services, and Section Head
Division of General Internal Medicine
Department of Medicine
University of Washington Medical Center

Sue K. Donaldson, Ph.D., R.N.*
Professor of Physiology
School of Medicine, and
Dean and Professor of Nursing
School of Nursing
Johns Hopkins University

Colin G. Drury, Ph.D.
Professor of Industrial Engineering
Department of Industrial Engineering
State University of New York

Michael Feuerstein, Ph.D.
Professor of Medical/Clinical Psychology and Preventive Medicine/Biometrics
Department of Medical and Clinical Psychology
Uniformed Services University
Bethesda, Md.

Baruch Fischhoff, Ph.D.*
University Professor
Departments of Social and Decision Sciences and of Engineering and Public Policy
Carnegie Mellon University

John W. Frymoyer, M.D.
Dean, College of Medicine; Emeritus Professor, Department of Orthopaedics and Rehabilitation; and Director, McClure Musculoskeletal Research Center
University of Vermont (retired)

Jeffrey N. Katz, M.D.
Associate Professor of Medicine
Division of Rheumatology, Immunology, and Allergy, and
Co-Director of the Spine Center
Brigham and Women's Hospital
Harvard Medical School

Kurt Kroenke, M.D.
Senior Research Scientist
Regenstrief Institute for Health Care, and
Professor of Medicine
Indiana University School of Medicine

Jeffrey C. Lotz, Ph.D.
Orthopaedic Bioengineering Laboratory
Department of Orthopaedic Surgery
University of California
San Francisco

Susan E. Mackinnon, M.D.
Shoenberg Professor and Chief
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis

William S. Marras, Ph.D.
Professor of Industrial and Systems Engineering, and
Co-Director of the Institute for Ergonomics
Department of Industrial, Welding, and Systems Engineering
Ohio State University

Robert G. Radwin, Ph.D.
Professor and Chair
Department of Biomedical Engineering
University of Wisconsin

David M. Rempel, M.D., M.P.H.
Professor of Medicine
Division of Occupational and
Environmental Medicine
University of California School of Medicine
San Francisco

Robert M. Szabo, M.D., M.P.H.
Chief, Hand and Microvascular Surgery
Department of Orthopaedics, and
Departments of Orthopaedic Surgery and of Surgery, Division of Plastic Surgery
University of California School of Medicine

David Vlahov, Ph.D.
Center for Urban Epidemiologic Studies
New York Academy of Medicine
New York City

David H. Wegman, M.D., M.Sc.
Professor and Chair
Department of Work Environment
College of Engineering
University of Massachusetts


Anne S. Mavor, M.S.
Study Director

Andrew M. Pope, Ph.D.
Director, Health Sciences Policy Division

Frederick J. Manning, Ph.D.
Senior Program Officer

* Member, Institute of Medicine